Healthcare Provider Details

I. General information

NPI: 1700184249
Provider Name (Legal Business Name): JANE M CHU N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 WILSHIRE BLVD SUITE 416
LOS ANGELES CA
90048-5201
US

IV. Provider business mailing address

6221 WILSHIRE BLVD SUITE 416
LOS ANGELES CA
90048-5201
US

V. Phone/Fax

Practice location:
  • Phone: 323-938-9999
  • Fax: 323-456-0880
Mailing address:
  • Phone: 323-938-9999
  • Fax: 323-456-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number718035
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19224
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number19224
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number19224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: