Healthcare Provider Details

I. General information

NPI: 1558288035
Provider Name (Legal Business Name): KATIE LEE CHAU
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19001 BROOKHURST ST
HUNTINGTON BEACH CA
92646-2551
US

IV. Provider business mailing address

9151 ATLANTA AVE
HUNTINGTON BEACH CA
92615-2639
US

V. Phone/Fax

Practice location:
  • Phone: 714-593-1352
  • Fax:
Mailing address:
  • Phone: 800-275-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberINT52393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: