Healthcare Provider Details

I. General information

NPI: 1396943833
Provider Name (Legal Business Name): SUFEN CHIU, M.D., PSYCHIATRIST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2657 PORTAGE BAY E STE 3
DAVIS CA
95616-3040
US

IV. Provider business mailing address

PO BOX 73284
DAVIS CA
95617-3284
US

V. Phone/Fax

Practice location:
  • Phone: 530-219-2750
  • Fax: 877-844-1699
Mailing address:
  • Phone: 530-219-2750
  • Fax: 877-844-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG86593
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG86593
License Number StateCA

VIII. Authorized Official

Name: DR. SUFEN CHIU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 530-219-2750