Provider Demographics
NPI:1942309703
Name:CHIU, VINCENT (PHD MD)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:CHIU
Suffix:
Gender:M
Credentials:PHD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 W ORANGE AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804
Mailing Address - Country:US
Mailing Address - Phone:714-527-6363
Mailing Address - Fax:714-527-2530
Practice Address - Street 1:3010 W ORANGE AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804
Practice Address - Country:US
Practice Address - Phone:714-527-6363
Practice Address - Fax:714-527-2530
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39166207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A391660Medicaid
CA00A391660Medicaid
A88488Medicare UPIN