Healthcare Provider Details

I. General information

NPI: 1568809168
Provider Name (Legal Business Name): WENDY M CHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 VENICE BLVD
LOS ANGELES CA
90034-3216
US

IV. Provider business mailing address

2319 ALTA ST
LOS ANGELES CA
90031-2845
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7115
  • Fax:
Mailing address:
  • Phone: 213-321-0174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberRPE 8244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: