Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 144879 | CA |
NPI | 1063807220 |
---|---|
Provider Name | Dr. Carissa Ellen Chu |
First Address | San Francisco, CA 94122-3524 |
Second Address | San Francisisco, CA 94143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2015 |
Last Update Date | 28/09/2016 |