=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013975838
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDMOND K CHU MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2006
-----------------------------------------------------
Last Update Date | 08/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3055 W ORANGE AVE STE 202
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92804-3154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-952-0203
-----------------------------------------------------
Fax | 714-952-1387
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3055 W ORANGE AVE STE 202
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92804-3154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-952-0203
-----------------------------------------------------
Fax | 714-952-1387
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | G34289
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------