Basic Information
Provider Information
NPI: 1033483607
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHU
FirstName: STEVEN
MiddleName: W
NamePrefix: DR.
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 480 ALTA RD
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921790001
CountryCode: US
TelephoneNumber: 6196616500
FaxNumber: 6196717588
Practice Location
Address1: 480 ALTA RD
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921790001
CountryCode: US
TelephoneNumber: 6196616500
FaxNumber: 6196717588
Other Information
ProviderEnumerationDate: 02/29/2012
LastUpdateDate: 02/29/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XB58801CAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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