Provider Demographics
NPI:1689636839
Name:CHU, JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:CHU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5717
Mailing Address - Country:US
Mailing Address - Phone:650-589-8988
Mailing Address - Fax:650-351-7721
Practice Address - Street 1:144 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5717
Practice Address - Country:US
Practice Address - Phone:650-589-8988
Practice Address - Fax:650-351-7721
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2015-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice