Basic Information
| Provider Information | |||||||||
| NPI: | 1528315819 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GO | ||||||||
| FirstName: | CHRISTINE GISEL | ||||||||
| MiddleName: | CHU | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHU | ||||||||
| OtherFirstName: | CHRISTINE GISEL | ||||||||
| OtherMiddleName: | WEE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6315 ARDEA COURT | ||||||||
| Address2: | |||||||||
| City: | GRANITE BAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465889520 | ||||||||
| FaxNumber: | 4238572070 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 RESPONSE RD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2764312648 | ||||||||
| FaxNumber: | 2764312082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2012 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | NONE | ZZ | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 0101253328 | VA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | A142476 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.