MEDICARE: COLLEEN CHIU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	106342	CA

General Provider Information

NPI Number	:	1013680511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN CHIU DDS

Provider Business Mailing Address
First Line	:	43 GOETTINGEN ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94134-1246
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	771 SACRAMENTO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-2504
Country	:	US
Telephone Number	:	415-362-3388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2021
Last Update Date	:	07/29/2021

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