Healthcare Provider Details

I. General information

NPI: 1730224668
Provider Name (Legal Business Name): PHILLIP C CHEW MSPAS, PA-C, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 WILSHIRE BLVD STE 745
LOS ANGELES CA
90025-1206
US

IV. Provider business mailing address

365 LENNON LN STE 250
WALNUT CREEK CA
94598-5915
US

V. Phone/Fax

Practice location:
  • Phone: 310-348-1900
  • Fax:
Mailing address:
  • Phone: 925-627-3424
  • Fax: 925-624-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: