Provider Demographics
NPI:1790907582
Name:CHIU, JOHN HUANGSEN (PA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HUANGSEN
Last Name:CHIU
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4816 SHE NAH NUM DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-9105
Mailing Address - Country:US
Mailing Address - Phone:360-459-5312
Mailing Address - Fax:
Practice Address - Street 1:4816 SHE NAH NUM DR SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-9105
Practice Address - Country:US
Practice Address - Phone:360-459-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003616363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS99241Medicare UPIN