Provider Demographics
NPI:1164758108
Name:CHIU, SHIH-TING (PA-C)
Entity Type:Individual
Prefix:
First Name:SHIH-TING
Middle Name:
Last Name:CHIU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AVIS
Other - Middle Name:
Other - Last Name:CHIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6644 MOUNT WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-1942
Mailing Address - Country:US
Mailing Address - Phone:626-679-1345
Mailing Address - Fax:
Practice Address - Street 1:15055 LOS GATOS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2056
Practice Address - Country:US
Practice Address - Phone:408-356-1000
Practice Address - Fax:408-356-1125
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13289171100000X
CAPA55529363A00000X
CA55529363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty