=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023459906
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WAI SHAN CHIU D.D.S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2013
-----------------------------------------------------
Last Update Date | 07/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 E ARQUES AVE STE 212
-----------------------------------------------------
City | SUNNYVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94085-5421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-749-9018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 355 N WOLFE RD APT215
-----------------------------------------------------
City | SUNNYVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94085-3892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-214-7752
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 61645
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------