MEDICARE: DR. JOHNSTON C CHU DDS

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	24957	CA

General Provider Information

NPI Number	:	1982734315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHNSTON C CHU DDS

Provider Business Mailing Address
First Line	:	2050 HUNTINGTON DR STE C
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4900
Country	:	US
Telephone Number	:	626-799-8918
Fax Number	:	626-799-7596

Provider Business Practice Location Address
First Line	:	2050 HUNTINGTON DR STE C
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4900
Country	:	US
Telephone Number	:	626-799-8918
Fax Number	:	626-799-7596

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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