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General NPI Number Information
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NPI Number | 1669537254
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Entity Type | Individual
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Provider Name | KENNETH CHU O.D.
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Gender | Male
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2033 SANTA ROSA PLZ
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City | SANTA ROSA
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State | CA
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Zip | 95401-6349
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Country | US
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Telephone | 707-544-0924
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Fax |
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Provider Business Mailing Address
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Address Line | 500 N ROSEMEAD BLVD UNIT 11
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City | PASADENA
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State | CA
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Zip | 91107-2104
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Country | US
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Telephone | 415-892-9750
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4514T
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License Number State | CA
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