Provider Demographics
NPI:1578731964
Name:CHIOU, WUN SAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WUN
Middle Name:SAN
Last Name:CHIOU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4154
Mailing Address - Country:US
Mailing Address - Phone:309-692-2335
Mailing Address - Fax:309-692-6134
Practice Address - Street 1:5505 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4154
Practice Address - Country:US
Practice Address - Phone:309-692-2335
Practice Address - Fax:309-692-6134
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19015191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist