Healthcare Provider Details

I. General information

NPI: 1124140355
Provider Name (Legal Business Name): GABRIEL HAM-CHANG CHIU JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9454 WILSHIRE BLVD GROUND FLOOR #108
BEVERLY HILLS CA
90212-2929
US

IV. Provider business mailing address

9454 WILSHIRE BLVD GROUND FLOOR #108
BEVERLY HILLS CA
90212-2929
US

V. Phone/Fax

Practice location:
  • Phone: 310-888-8087
  • Fax: 310-246-1910
Mailing address:
  • Phone: 310-888-8087
  • Fax: 310-246-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number20A8619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: