Provider Demographics
NPI:1992994412
Name:CHU, PEN-MAO (DDS)
Entity type:Individual
Prefix:DR
First Name:PEN-MAO
Middle Name:
Last Name:CHU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7938 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2354
Mailing Address - Country:US
Mailing Address - Phone:213-675-2089
Mailing Address - Fax:714-670-9663
Practice Address - Street 1:7938 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-2354
Practice Address - Country:US
Practice Address - Phone:714-670-7657
Practice Address - Fax:714-670-9663
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice