Healthcare Provider Details

I. General information

NPI: 1073193140
Provider Name (Legal Business Name): JENNY CHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 CAMFIELD AVE
COMMERCE CA
90040-1501
US

IV. Provider business mailing address

1850 PARK ROSE AVE
DUARTE CA
91010-3247
US

V. Phone/Fax

Practice location:
  • Phone: 323-889-7353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95160501
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07241396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: