Basic Information
| Provider Information | |||||||||
| NPI: | 1588832349 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GEORGE J. CHU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1329 LUSITANA ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085321311 | ||||||||
| FaxNumber: | 8085362224 | ||||||||
| Practice Location | |||||||||
| Address1: | 1329 LUSITANA ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085321311 | ||||||||
| FaxNumber: | 8085362224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2008 | ||||||||
| LastUpdateDate: | 02/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHU | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 8085321311 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GEORGE J. CHU | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 3268 | HI | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 04458201 | 05 | HI | MEDICAID | 00F049764 | 01 | HI | HMSA | OTHER | A49765 | 01 | HI | HMSA | OTHER | 1513622 | 01 | CHAMPUS | OTHER | 0000BDRTD | 01 | MEDICARE | OTHER |