Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G42101 | CA |
NPI | 1033183413 |
---|---|
Provider Name | Dennis Alvin Chuck |
First Address | Pomona, CA 91768-1727 |
Second Address | Pomona, CA 91768-1727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 08/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G42101 | (02) |