Provider Demographics
NPI:1033183413
Name:CHUCK, DENNIS ALVIN (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:ALVIN
Last Name:CHUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1774 ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-1727
Mailing Address - Country:US
Mailing Address - Phone:909-622-1188
Mailing Address - Fax:909-623-4768
Practice Address - Street 1:1774 ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-1727
Practice Address - Country:US
Practice Address - Phone:909-622-1188
Practice Address - Fax:909-623-4768
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG42101207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G42101Medicare UPIN