Provider Demographics
NPI:1891703013
Name:CHIU, SAMUEL KING (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:KING
Last Name:CHIU
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 1:451 CASTRO STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041
Mailing Address - Country:US
Mailing Address - Phone:650-988-8828
Mailing Address - Fax:650-988-8878
Practice Address - Street 1:451 CASTRO STREET
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041
Practice Address - Country:US
Practice Address - Phone:650-988-8828
Practice Address - Fax:650-988-8878
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3764201OtherMEDI CAL