Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 32719 | TX |
NPI | 1083955264 |
---|---|
Provider Name | Dr. Jerry Chiu |
First Address | Austin, TX 78701-4762 |
Second Address | Austin, TX 78731-6220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2013 |
Last Update Date | 06/01/2022 |