Provider Demographics
NPI:1437296324
Name:CHU, DUC KY (MD)
Entity type:Individual
Prefix:
First Name:DUC
Middle Name:KY
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 1:329 BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-1604
Mailing Address - Country:US
Mailing Address - Phone:781-596-1714
Mailing Address - Fax:781-596-7484
Practice Address - Street 1:329 BOSTON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-1604
Practice Address - Country:US
Practice Address - Phone:781-596-1714
Practice Address - Fax:781-596-7484
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53347208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3001326Medicaid
B76106Medicare UPIN
MA3001326Medicaid