Healthcare Provider Details

I. General information

NPI: 1134819170
Provider Name (Legal Business Name): MARY GRACE KANEN CHIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST STE 500
HOUSTON TX
77030-3005
US

IV. Provider business mailing address

6431 FANNIN ST STE JJL 480
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-5800
  • Fax:
Mailing address:
  • Phone: 713-500-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW4436
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: