Provider Demographics
NPI:1316970759
Name:NOEL TD CHIU MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:NOEL TD CHIU MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-754-6767
Mailing Address - Street 1:PO BOX 1312
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-7312
Mailing Address - Country:US
Mailing Address - Phone:925-754-6767
Mailing Address - Fax:925-754-0137
Practice Address - Street 1:3436 HILLCREST AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6304
Practice Address - Country:US
Practice Address - Phone:925-754-6767
Practice Address - Fax:925-754-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75814207ND0101X, 207ND0900X, 207NI0002X, 207NP0225X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A758140Medicaid
CAZZZ65527ZOtherBLUE SHIELD ID
CAZZZ65527ZOtherBLUE SHIELD ID