Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 550053 | TX |
NPI | 1003127259 |
---|---|
Provider Name | Dr. Ilene Chiu |
First Address | Dallas, TX 75390-7208 |
Second Address | Fort Worth, TX 76104-2410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 29/04/2021 |