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General NPI Number Information
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NPI Number | 1457765638
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Entity Type | Individual
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Provider Name | JENNIFER CHU-SMITH MD
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Gender | Female
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 971 11TH AVE
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City | LONGVIEW
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State | WA
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Zip | 98632-2503
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Country | US
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Telephone | 360-577-1771
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Fax | 360-423-9537
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Provider Business Mailing Address
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Address Line | 971 11TH AVE
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City | LONGVIEW
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State | WA
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Zip | 98632-2503
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Country | US
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Telephone | 360-577-1771
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Fax | 360-423-9537
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD60757706
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License Number State | WA
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