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General NPI Number Information
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NPI Number | 1972597938
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Entity Type | Individual
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Provider Name | JANICE CHUA GO MD
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Gender | Female
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 3585 LEXINGTON AVE N SUITE 350
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City | SHOREVIEW
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State | MN
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Zip | 55126-8064
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Country | US
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Telephone | 651-484-3942
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Fax | 651-787-0519
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Provider Business Mailing Address
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Address Line | 3585 LEXINGTON AVE N SUITE 350
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City | SHOREVIEW
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State | MN
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Zip | 55126-8064
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Country | US
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Telephone | 651-251-5280
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Fax | 651-251-5282
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 41894
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 41894
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License Number State | MN
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