MEDICARE: DR. DAVIS CO CHU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	11087	NV
2	208000000X	Pediatrics Physician	11087	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205842796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVIS CO CHU M.D.

Provider Business Mailing Address
First Line	:	1219 E CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-1708
Country	:	US
Telephone Number	:	702-633-5410
Fax Number	:	702-320-1639

Provider Business Practice Location Address
First Line	:	1219 E CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-1708
Country	:	US
Telephone Number	:	702-633-5410
Fax Number	:	702-320-1639

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	11/09/2012

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