Healthcare Provider Details

I. General information

NPI: 1073044889
Provider Name (Legal Business Name): ELAINE CHIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 08/01/2024
Certification Date: 03/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 EUREKA RD STE 21
ROSEVILLE CA
95661-3027
US

IV. Provider business mailing address

1600 EUREKA RD STE 21
ROSEVILLE CA
95661-3027
US

V. Phone/Fax

Practice location:
  • Phone: 916-474-2250
  • Fax:
Mailing address:
  • Phone: 916-474-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.152874
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number162039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: