Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | G12838 | CA |
N | 207RA0201X | Internist - Allergy & Immunology | G12838 | CA |
NPI | 1194765123 |
---|---|
Provider Name | Dr. Theodore J Chu |
First Address | San Jose, CA 95128-1729 |
Second Address | San Jose, CA 95128-1729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 16/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A38792 | (02) |