Individual provider Active NPI

Jae S Chu, M.D.

  • Internal Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1063400745
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A46356 Issued in CA
Practice address
12610 S Western Ave
Los Angeles, CA 90047-5252
Phone
(323) 757-1853
Fax
(323) 757-1281
NPI assigned
Oct 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A46356 CA Primary

Addresses

Primary practice location

12610 S Western Ave
Los Angeles, CA 90047-5252

Mailing address

12610 S Western Ave
Los Angeles, CA 90047-5252
Phone (323) 757-1853

Other identifiers 1

IdentifierTypeStateIssuer
00A463560MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100918000098 CA Practitioner - Internal Medicine 6507981206 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wayne State University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Purpose Driven Mobile PhysicianGroup PAC ID 1557803673, 3 clinicians

Practice addresses (Care Compare)

4221 Wilshire Blvd
Suite 170 8
Los Angeles, CA 90010-3519
Phone (213) 755-9965

Hospital & facility affiliations

  • Fast Recovery Home Health Care, Inc Home health agency, Buena Park, CA, CCN 559503
  • Honest Home Health Care Services Inc Home health agency, Los Angeles, CA, CCN 559786
  • Mid-Wilshire Health Care CNTR Nursing home, Los Angeles, CA, CCN 056174

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Purpose Driven Mobile Physician CurrentSince Apr 7, 2024 Accepting new patients

Locations

4221 Wilshire Blvd
Ste 170-8
Los Angeles, CA 90010
Phone (213) 755-9965

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1063400745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12610 S WESTERN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900475252",
            "telephone_number": "323-757-1853",
            "fax_number": "323-757-1281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12610 S WESTERN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900475252",
            "telephone_number": "323-757-1853",
            "fax_number": "323-757-1281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHU",
        "first_name": "JAE",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A46356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A463560",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.