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General NPI Number Information
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NPI Number | 1003258351
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Entity Type | Individual
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Provider Name | LARINA CHU DDS
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Gender | Female
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Dates
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Enumeration Date | 07/26/2013
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Last Update Date | 12/11/2018
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Provider Practice Location Address
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Address Line | 14285 SEVENTH ST
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City | VICTORVILLE
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State | CA
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Zip | 92395-4207
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Country | US
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Telephone | 760-388-5080
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Fax |
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Provider Business Mailing Address
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Address Line | 11941 HESPERIA RD
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City | HESPERIA
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State | CA
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Zip | 92345-1855
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Country | US
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Telephone | 760-490-0790
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Fax | 760-990-7373
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 60879
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 60879
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License Number State | CA
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