Healthcare Provider Details

I. General information

NPI: 1407588858
Provider Name (Legal Business Name): NICHOLAS THONG AU MSN, APRN, AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E BADILLO ST
COVINA CA
91723-2116
US

IV. Provider business mailing address

235 E BADILLO ST
COVINA CA
91723-2116
US

V. Phone/Fax

Practice location:
  • Phone: 626-915-4700
  • Fax: 626-214-7814
Mailing address:
  • Phone: 626-915-4700
  • Fax: 626-214-7814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95275145
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95036173
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: