Basic Information
| Provider Information | |||||||||
| NPI: | 1598169815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHARD | ||||||||
| FirstName: | CHU JUN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1108 W INDIAN SCHOOL RD | ||||||||
| Address2: | STE B | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850133107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027735600 | ||||||||
| FaxNumber: | 6027735601 | ||||||||
| Practice Location | |||||||||
| Address1: | 1936 MAGAZINE ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701305016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045295558 | ||||||||
| FaxNumber: | 5045298840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2014 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | AP7282 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 980049 | 05 | AZ | MEDICAID |