MEDICARE: DR. JACKSON CHUNKIT CHIU M.D.

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	2084P0800X	Psychiatry Physician	38313	NC
2	2085R0202X	Diagnostic Radiology Physician	38313	NC

General Provider Information

NPI Number	:	1972820231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACKSON CHUNKIT CHIU M.D.

Provider Business Mailing Address
First Line	:	2701 MONTCASTLE CT
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-5763
Country	:	US
Telephone Number	:	919-452-1160
Fax Number	:

Provider Business Practice Location Address
First Line	:	7404 CHAPEL HILL RD STE A
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-5043
Country	:	US
Telephone Number	:	919-452-1160
Fax Number	:

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

Provider Enumeration Date	:	04/27/2010
Last Update Date	:	04/27/2010

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