Active NPI
Derek Chu
- Endodontics
- San Jose, CA
National Provider Identifier
1063654093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 52719
- Practice address
- 2139 Tully Rd
San Jose, CA 95122-1346 - Phone
- (408) 256-5660
- NPI assigned
- Apr 6, 2009
- Last updated
- Aug 19, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 52719 | CA | Primary |
Addresses
Primary practice location
2139 Tully Rd
San Jose, CA 95122-1346
Mailing address
2139 Tully Rd
San Jose, CA 95122-1346
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52719 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376870400000",
"number": "1063654093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2139 TULLY RD",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951221346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2139 TULLY RD",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951221346",
"telephone_number": "408-256-5660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHU",
"first_name": "DEREK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-06",
"last_updated": "2013-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "52719",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.