Provider Demographics
NPI:1164457370
Name:CHUA, HENRY S (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:S
Last Name:CHUA
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 1:7475 CAMINO ARROYO
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7348
Mailing Address - Country:US
Mailing Address - Phone:888-334-1000
Mailing Address - Fax:408-852-2265
Practice Address - Street 1:7475 CAMINO ARROYO
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7348
Practice Address - Country:US
Practice Address - Phone:888-334-1000
Practice Address - Fax:408-852-2265
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G72016Medicare UPIN