Healthcare Provider Details

I. General information

NPI: 1780095216
Provider Name (Legal Business Name): CHRISTOPHER T CHIU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2561 MERCED ST
SAN LEANDRO CA
94577-4207
US

IV. Provider business mailing address

2415 SAN RAMON VALLEY BLVD STE 4-831
SAN RAMON CA
94583-5381
US

V. Phone/Fax

Practice location:
  • Phone: 510-969-0788
  • Fax:
Mailing address:
  • Phone: 510-398-1412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number1727
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number63100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: