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General NPI Number Information
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NPI Number | 1649796632
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Entity Type | Individual
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Provider Name | WAYLAND CHU
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Gender | Male
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 24981 DANA POINT HARBOR DR STE 120
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City | DANA POINT
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State | CA
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Zip | 92629-2931
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Country | US
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Telephone | 949-441-5965
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Fax |
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Provider Business Mailing Address
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Address Line | 12170 WYNE CT
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City | TUSTIN
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State | CA
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Zip | 92782-1184
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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 |
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 101908
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License Number State | CA
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