Healthcare Provider Details

I. General information

NPI: 1316970759
Provider Name (Legal Business Name): NOEL TD CHIU MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3436 HILLCREST AVE SUITE 150
ANTIOCH CA
94531-6304
US

IV. Provider business mailing address

PO BOX 1312
ALAMO CA
94507-7312
US

V. Phone/Fax

Practice location:
  • Phone: 925-754-6767
  • Fax: 925-754-0137
Mailing address:
  • Phone: 925-754-6767
  • Fax: 925-754-0137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA75814
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA75814
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberA75814
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberA75814
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA75814
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA75814
License Number StateCA

VIII. Authorized Official

Name: DR. NOEL CHIU
Title or Position: OWNER
Credential: M.D.
Phone: 925-754-6767