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General NPI Number Information
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NPI Number | 1457664856
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Entity Type | Organization
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Legal Business Name | BRIAN CHU, D.D.S., INC.
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 11/08/2010
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Provider Practice Location 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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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 | CEO
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Name | DR. BRIAN CHU
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Credential | D.D.S.
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Telephone | 760-490-0790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 51245
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License Number State | CA
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