Healthcare Provider Details

I. General information

NPI: 1821049669
Provider Name (Legal Business Name): LAN L. NGUYEN CHAWKINS PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 W MAIN ST STE 100
ALHAMBRA CA
91801-1951
US

IV. Provider business mailing address

1635 W MAIN ST STE 100
ALHAMBRA CA
91801-1951
US

V. Phone/Fax

Practice location:
  • Phone: 626-248-1800
  • Fax:
Mailing address:
  • Phone: 626-248-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberCP16422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: