MEDICARE: DR. SHE-TEEN CHIU D.O.

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	2084P0804X	Child & Adolescent Psychiatry Physician	269767	MA
2	2084P0800X	Psychiatry Physician	20A7221	CA

General Provider Information

NPI Number	:	1871613349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHE-TEEN CHIU D.O.

Provider Business Mailing Address
First Line	:	11631 VICTORY BLVD STE 203
Second Line	:
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91606-3572
Country	:	US
Telephone Number	:	310-809-6333
Fax Number	:

Provider Business Practice Location Address
First Line	:	11631 VICTORY BLVD STE 203
Second Line	:
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91606-3572
Country	:	US
Telephone Number	:	310-809-6333
Fax Number	:

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	04/28/2021

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