Active NPI
Kristeen Chu, DDS
- Pediatric Dentistry
- Los Angeles, CA
National Provider Identifier
1083248926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 105760
- Practice address
- 2010 Zonal Ave # 5P77
Los Angeles, CA 90033-1026 - Phone
- (760) 687-5705
- NPI assigned
- Mar 1, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 105760 | CA | Primary |
Addresses
Primary practice location
2010 Zonal Ave # 5P77
Los Angeles, CA 90033-1026
Mailing address
8682 Hatteras Dr
Huntington Beach, CA 92646-7024
Phone (760) 687-5705
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241204002480 | CA | Order and Referring Only - Dentist | 6608302484 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105760 | CA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730937600000",
"number": "1083248926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8682 HATTERAS DR",
"city": "HUNTINGTON BEACH",
"state": "CA",
"postal_code": "926467024",
"telephone_number": "760-687-5705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2010 ZONAL AVE # 5P77",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331026",
"telephone_number": "760-687-5705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHU",
"first_name": "KRISTEEN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-01",
"last_updated": "2024-11-07",
"certification_date": "2024-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "105760",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.