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General NPI Number Information
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NPI Number | 1629589759
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Entity Type | Organization
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Legal Business Name | CH DENTISTRY, DENTAL OFFICE OF CHU AND CHU, INC.
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 626 S PRIMROSE AVE
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City | MONROVIA
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State | CA
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Zip | 91016-3434
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Country | US
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Telephone | 626-893-4484
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Fax |
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Provider Business Mailing Address
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Address Line | 626 S PRIMROSE AVE
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City | MONROVIA
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State | CA
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Zip | 91016-3434
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTINE CHU
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Credential | DDS
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Telephone | 626-775-5118
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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 | 61087
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 64248
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License Number State | CA
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