Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 52719 | CA |
NPI | 1063654093 |
---|---|
Provider Name | Derek Chu |
First Address | San Jose, CA 95122-1346 |
Second Address | San Jose, CA 95122-1346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2009 |
Last Update Date | 19/08/2013 |