MEDICARE: DR. JEAN CHU D.D.S.

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	1223G0001X	General Practice Dentistry	30636	CA

General Provider Information

NPI Number	:	1689636839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN CHU D.D.S.

Provider Business Mailing Address
First Line	:	144 BRENTWOOD DR
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-5717
Country	:	US
Telephone Number	:	650-589-8988
Fax Number	:	650-351-7721

Provider Business Practice Location Address
First Line	:	144 BRENTWOOD DR
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-5717
Country	:	US
Telephone Number	:	650-589-8988
Fax Number	:	650-351-7721

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	04/18/2015

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Directions to “ DR. JEAN CHU D.D.S.” Practice Location

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