1003958281 NPI number — WAN YI CHU & CHAO KUEI CHEN DDS INC

Table of content: MR. EDWARD THOMAS WALSH II RN (NPI 1063744555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003958281 NPI number — WAN YI CHU & CHAO KUEI CHEN DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAN YI CHU & CHAO KUEI CHEN DDS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003958281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10990 LOWER AZUSA RD
Provider Second Line Business Mailing Address:
#6
Provider Business Mailing Address City Name:
EL MONTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-448-4288
Provider Business Mailing Address Fax Number:
626-448-1978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10990 LOWER AZUSA RD
Provider Second Line Business Practice Location Address:
#6
Provider Business Practice Location Address City Name:
EL MONTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-448-4288
Provider Business Practice Location Address Fax Number:
626-448-1978
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHU
Authorized Official First Name:
WAN YI
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST OFFICER
Authorized Official Telephone Number:
626-448-4288

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  39950141067 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9175001 . This is a "DENTI CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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