Provider Demographics
NPI:1821377342
Name:CHIU, CONNIE GING TING (MD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:GING TING
Last Name:CHIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 6TH ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2446
Mailing Address - Country:US
Mailing Address - Phone:310-980-0690
Mailing Address - Fax:
Practice Address - Street 1:2200 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2302
Practice Address - Country:US
Practice Address - Phone:310-449-5268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117934208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery