Provider Demographics
NPI:1063400745
Name:CHU, JAE S (MD)
Entity type:Individual
Prefix:DR
First Name:JAE
Middle Name:S
Last Name:CHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12610 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-5252
Mailing Address - Country:US
Mailing Address - Phone:323-757-1853
Mailing Address - Fax:323-757-1281
Practice Address - Street 1:12610 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-5252
Practice Address - Country:US
Practice Address - Phone:323-757-1853
Practice Address - Fax:323-757-1281
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A463560Medicaid
CAE29998Medicare UPIN
CAJCA46356Medicare ID - Type Unspecified