Healthcare Provider Details

I. General information

NPI: 1184536112
Provider Name (Legal Business Name): IVY CHAN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BALDWIN PARK BLVD
BALDWIN PARK CA
91706-5806
US

IV. Provider business mailing address

1011 BALDWIN PARK BLVD
BALDWIN PARK CA
91706-5806
US

V. Phone/Fax

Practice location:
  • Phone: 626-813-4788
  • Fax:
Mailing address:
  • Phone: 626-813-4788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SN0000X
TaxonomyNeonatal Clinical Nurse Specialist
License Number5252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: