=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548581721
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN Y CHEW MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2010
-----------------------------------------------------
Last Update Date | 01/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1955 SUNNYCREST DR SUITE 108
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835-3654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-441-0133
-----------------------------------------------------
Fax | 714-441-1082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1955 SUNNYCREST DR SUITE 108
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835-3654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-441-0133
-----------------------------------------------------
Fax | 714-441-1082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN Y CHEW
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 714-441-0133
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | G17171
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------