Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 60879 | CA |
Y | 1223D0004X | Dentist Anesthesiologist | 60879 | CA |
NPI | 1003258351 |
---|---|
Provider Name | Dr. Larina Chu |
First Address | Hesperia, CA 92345-1855 |
Second Address | Victorville, CA 92395-4207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2013 |
Last Update Date | 11/12/2018 |