Provider Demographics
NPI:1447904628
Name:CHIU, EDWARD LO
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:LO
Last Name:CHIU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 COLLINS DR APT 12
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3129
Mailing Address - Country:US
Mailing Address - Phone:209-500-9562
Mailing Address - Fax:
Practice Address - Street 1:6169 N THESTA ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5266
Practice Address - Country:US
Practice Address - Phone:559-435-1757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty