| G Samuel S Chua Md, A Professional Medical Corporation | |
|
96 Springstowne Center Suite B Vallejo CA 94591-5566 | |
| (707) 649-2228 | |
| (707) 649-0120 |
| Full Name | G Samuel S Chua Md, A Professional Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 96 Springstowne Center, Vallejo, California |
| Authorized Official Name and Position | Gabriel Samuel Siy Chua (PRESIDENT) |
| Authorized Official Contact | 7076492228 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| G Samuel S Chua Md, A Professional Medical Corporation 96 Springstowne Center Suite B Vallejo CA 94591-5566 Ph: (707) 649-2228 | G Samuel S Chua Md, A Professional Medical Corporation 96 Springstowne Center Suite B Vallejo CA 94591-5566 Ph: (707) 649-2228 |
| NPI Number | 1598917981 |
|---|---|
| Provider Enumeration Date | 10/16/2008 |
| Last Update Date | 12/09/2016 |
| Medicare PECOS PAC ID | 1456518968 |
|---|---|
| Medicare Enrollment ID | O20120210000040 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598917981 | NPI | - | NPPES |
| 00A493990 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A49399 (California) | Primary |
| 207RP1001X | Internal Medicine - Pulmonary Disease | A41529 (California) | Secondary |
| Provider Name | Gabriel Samuel S Chua |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265476428 PECOS PAC ID: 7315932134 Enrollment ID: I20040419001818 |
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