Provider Demographics
NPI:1811998065
Name:CHIOU, ANGELA PORTIA (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:PORTIA
Last Name:CHIOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PORTIA
Other - Middle Name:
Other - Last Name:CHIOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 4206
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-4206
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:720 N TUSTIN AVE
Practice Address - Street 2:STE. 202
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3606
Practice Address - Country:US
Practice Address - Phone:714-210-5886
Practice Address - Fax:714-210-5890
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79877208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Not Answered2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A798770Medicaid
A79877Medicare ID - Type Unspecified
CA00A798770Medicaid