MEDICARE: MR. JOHN HUANGSEN CHIU PA

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	363A00000X	Physician Assistant	PA10003616	WA

General Provider Information

NPI Number	:	1790907582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN HUANGSEN CHIU PA

Provider Business Mailing Address
First Line	:	4816 SHE NAH NUM DR SE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98513-9105
Country	:	US
Telephone Number	:	360-459-5312
Fax Number	:

Provider Business Practice Location Address
First Line	:	4816 SHE NAH NUM DR SE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98513-9105
Country	:	US
Telephone Number	:	360-459-5312
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	12/05/2011

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