MEDICARE: JENNIFER CHIU CCP

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	242T00000X	Perfusionist	059017	CA

General Provider Information

NPI Number	:	1881811305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CHIU CCP

Provider Business Mailing Address
First Line	:	1405 OAK GROVE AVE
Second Line	:	APT. 306
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3775
Country	:	US
Telephone Number	:	650-815-1921
Fax Number	:	650-615-9995

Provider Business Practice Location Address
First Line	:	1405 OAK GROVE AVE
Second Line	:	APT. 306
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3775
Country	:	US
Telephone Number	:	650-815-1921
Fax Number	:	650-615-9995

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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Directions to “ JENNIFER CHIU CCP” Practice Location

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