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General NPI Number Information
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NPI Number | 1740547835
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Entity Type | Individual
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Provider Name | KWANG POUNG CHIU M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 2089 VALE RD SUIT 24
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City | SAN PABLO
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State | CA
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Zip | 94806
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Country | US
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Telephone | 510-367-3833
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Fax | 510-235-9907
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Provider Business Mailing Address
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Address Line | 1390 SUMMIT PARK LANE
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City | ELCERRITO
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State | CA
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Zip | 94530
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Country | US
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Telephone | 510-236-3745
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Fax | 510-235-9907
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | C37989
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License Number State | CA
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