Healthcare Provider Details

I. General information

NPI: 1700762010
Provider Name (Legal Business Name): DESIREE CHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13299 SOUTH ST
CERRITOS CA
90703-7307
US

IV. Provider business mailing address

13299 SOUTH ST
CERRITOS CA
90703-7307
US

V. Phone/Fax

Practice location:
  • Phone: 562-623-7078
  • Fax:
Mailing address:
  • Phone: 657-348-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95036239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: