Healthcare Provider Details

I. General information

NPI: 1295314342
Provider Name (Legal Business Name): JACQUELINE TIEN HSIN CHU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9122 ADAMS AVE
HUNTINGTON BEACH CA
92646-3405
US

IV. Provider business mailing address

9122 ADAMS AVE
HUNTINGTON BEACH CA
92646-3405
US

V. Phone/Fax

Practice location:
  • Phone: 714-378-0900
  • Fax: 714-378-5166
Mailing address:
  • Phone: 714-378-0900
  • Fax: 714-378-5166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number59646
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: