Healthcare Provider Details

I. General information

NPI: 1346342102
Provider Name (Legal Business Name): CYNTHIA CHAU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E DOMINGUEZ ST SUITE 110
CARSON CA
90746-3600
US

IV. Provider business mailing address

845 CLEVELAND ST APT 1
LOS ANGELES CA
90012-1652
US

V. Phone/Fax

Practice location:
  • Phone: 310-715-7755
  • Fax: 310-366-7711
Mailing address:
  • Phone: 213-624-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA14986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: