Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G47843 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | G47843 | CA |
NPI | 1841251105 |
---|---|
Provider Name | Dr. Joseph Chudy |
First Address | Concord, CA 94520-3279 |
Second Address | Ione, CA 95640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 09/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A50831 | (02) | CA |