Provider Demographics
NPI:1972547685
Name:CHU, JONATHAN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
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 1:3137 S. MERIDIAN RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-947-6800
Mailing Address - Fax:208-947-6806
Practice Address - Street 1:3137 S MERIDIAN RD
Practice Address - Street 2:SUITE 120
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7080
Practice Address - Country:US
Practice Address - Phone:208-947-6800
Practice Address - Fax:208-947-6806
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003642000Medicaid
ID003642000Medicaid
F31445Medicare UPIN