Provider Demographics
NPI:1750635355
Name:CHIU, CHUN FAN
Entity type:Individual
Prefix:MS
First Name:CHUN FAN
Middle Name:
Last Name:CHIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 BAY PKWY
Mailing Address - Street 2:A21
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2662
Mailing Address - Country:US
Mailing Address - Phone:718-864-1912
Mailing Address - Fax:
Practice Address - Street 1:8200 BAY PKWY
Practice Address - Street 2:A21
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2662
Practice Address - Country:US
Practice Address - Phone:718-864-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-04
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1875666390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program