Provider Demographics
NPI:1699736843
Name:CHIU, DIANE S (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:S
Last Name:CHIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 OLIVE WAY
Mailing Address - Street 2:MS:M4-PA
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:1200 112TH AVE NE STE C187
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3749
Practice Address - Country:US
Practice Address - Phone:425-457-7900
Practice Address - Fax:425-457-7499
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0043597207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00150518OtherRAIL ROAD MEDICARE
WA1159CHOtherINDIVIDUAL BLUE SHIELD
WA8411654Medicaid
WA0039576OtherL&I
WA1159CHOtherINDIVIDUAL BLUE SHIELD
WA8807927Medicare PIN