Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 20A8619 | CA |
NPI | 1124140355 |
---|---|
Provider Name | Dr. Gabriel Ham-Chang Chiu JR. |
First Address | Beverly Hills, CA 90212-2929 |
Second Address | Beverly Hills, CA 90212-2929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 03/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20A8619 | MEDICAL LICENSE NO. (01) | CA |
BC7314999 | DEA NO. (01) | CA |