MEDICARE: MISS NICOLE PUI-MING CHIU DMD, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	59495	CA

General Provider Information

NPI Number	:	1326354804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NICOLE PUI-MING CHIU DMD, MS

Provider Business Mailing Address
First Line	:	946 STOCKTON ST APT 10F
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-1643
Country	:	US
Telephone Number	:	203-918-6808
Fax Number	:

Provider Business Practice Location Address
First Line	:	946 STOCKTON ST APT 10F
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-1643
Country	:	US
Telephone Number	:	203-918-6808
Fax Number	:

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

Provider Enumeration Date	:	08/23/2010
Last Update Date	:	09/15/2010

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