Healthcare Provider Details

I. General information

NPI: 1104279348
Provider Name (Legal Business Name): JEFF W CHIU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 S BACOM AVE
SAN JOSE CA
95128
US

IV. Provider business mailing address

1001 GALAXY WAY STE 400
CONCORD CA
94520-5725
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5000
  • Fax: 513-715-4076
Mailing address:
  • Phone: 925-482-8402
  • Fax: 925-482-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A15789
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A15789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: