Provider Demographics
NPI:1194765123
Name:CHU, THEODORE J (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:J
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 1:130 BELLEROSE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1729
Mailing Address - Country:US
Mailing Address - Phone:408-816-8923
Mailing Address - Fax:669-242-7914
Practice Address - Street 1:130 BELLEROSE DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1729
Practice Address - Country:US
Practice Address - Phone:408-816-8923
Practice Address - Fax:669-242-7914
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12838207RA0201X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0050106OtherDEA
CAAC0050106OtherDEA