Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | MD60970789 | WA |
NPI | 1023389061 |
---|---|
Provider Name | Henry Chu |
First Address | Vancouver, WA 98664-4896 |
Second Address | Vancouver, WA 98664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2012 |
Last Update Date | 29/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
113780 | SID # 113780 (01) | CA |