Provider Demographics
NPI:1740338151
Name:CHIU, PETER HOR-TAO (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:HOR-TAO
Last Name:CHIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1564 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4154
Mailing Address - Country:US
Mailing Address - Phone:323-255-2799
Mailing Address - Fax:
Practice Address - Street 1:416 W LAS TUNAS DR
Practice Address - Street 2:SUITE303
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1236
Practice Address - Country:US
Practice Address - Phone:626-299-7100
Practice Address - Fax:626-299-7103
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG076879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G768790Medicaid
CAG076879OtherSTATE LICENSE
CA7914016OtherAETNA
CAG076879OtherBLUE CROSS
CA0076890OtherBLUE SHIELD
CA95-4803693OtherTAX ID
CABC3812167OtherDEA
CAG076879OtherBLUE CROSS
CA95-4803693OtherTAX ID