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General NPI Number Information
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NPI Number | 1346477023
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Entity Type | Organization
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Legal Business Name | PEN-MAO CHU, A PROFESSIONAL DENTAL CORP.
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 01/16/2010
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Provider Practice Location Address
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Address Line | 7938 VALLEY VIEW ST
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City | BUENA PARK
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State | CA
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Zip | 90620-2354
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Country | US
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Telephone | 714-670-7657
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Fax | 714-670-9663
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Provider Business Mailing Address
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Address Line | 7938 VALLEY VIEW ST
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City | BUENA PARK
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State | CA
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Zip | 90620-2354
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Country | US
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Telephone | 213-675-2089
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PEN-MAO CHU
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Credential | DDS
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Telephone | 213-675-2089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 51244
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License Number State | CA
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