Provider Demographics
NPI:1114208287
Name:PETER HOR-TAO CHIU
Entity type:Organization
Organization Name:PETER HOR-TAO CHIU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-299-7100
Mailing Address - Street 1:416 W LAS TUNAS DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1236
Mailing Address - Country:US
Mailing Address - Phone:626-299-7100
Mailing Address - Fax:626-299-7103
Practice Address - Street 1:416 W LAS TUNAS DR
Practice Address - Street 2:SUITE 303
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG076879OtherSTATE LICENSE
CA00G768790Medicaid
CA0076890OtherBLUE SHIELD
CA7914016OtherAETNA
CAG076879OtherBLUE CROSS
CAG076879OtherBLUE CROSS
CAG01154Medicare UPIN
CAG76879Medicare PIN