Healthcare Provider Details

I. General information

NPI: 1114769965
Provider Name (Legal Business Name): KA MEI TONG CHUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KA MEI TONG

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 09/23/2026
Certification Date: 06/12/2024
Deactivation Date: 02/19/2025
Reactivation Date: 09/23/2026

III. Provider practice location address

1133 CRENSHAW BLVD
LOS ANGELES CA
90019
US

IV. Provider business mailing address

1133 CRENSHAW BLVD
LOS ANGELES CA
90019
US

V. Phone/Fax

Practice location:
  • Phone: 310-553-2695
  • Fax:
Mailing address:
  • Phone: 310-553-2695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: