Healthcare Provider Details

I. General information

NPI: 1851266423
Provider Name (Legal Business Name): SOO AE CHIHARU HENDRON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 N AVIATION BLVD
EL SEGUNDO CA
90245-2808
US

IV. Provider business mailing address

9 LILAC
IRVINE CA
92618-6908
US

V. Phone/Fax

Practice location:
  • Phone: 310-653-6032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2369034
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: