Provider Demographics
NPI:1285664375
Name:CHIU, VICTOR W (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:W
Last Name:CHIU
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 1:3602 S 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:559-733-4372
Mailing Address - Fax:559-733-1758
Practice Address - Street 1:3602 S 19TH STREET
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:559-733-4372
Practice Address - Fax:559-733-1758
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96009207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11633790OtherCAQH PROVIDER ID#
CAGR0101220Medicaid
CA00A960090Medicaid
MNR068154165714OtherDRIVERS LICENSE NUMBER
MNR068154165714OtherDRIVERS LICENSE NUMBER
CAZZZ035062ZMedicare ID - Type UnspecifiedGROUP MEDICARE#
CA00A960090Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE#
CA11633790OtherCAQH PROVIDER ID#