Provider Demographics
NPI:1962736975
Name:CHU, OLIVER (DMD)
Entity type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:
Last Name:CHU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 SPYGLASS LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2041
Mailing Address - Country:US
Mailing Address - Phone:909-979-4662
Mailing Address - Fax:
Practice Address - Street 1:219 SPYGLASS LN
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2041
Practice Address - Country:US
Practice Address - Phone:909-979-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57622122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice