Healthcare Provider Details

I. General information

NPI: 1467634022
Provider Name (Legal Business Name): CINDY WING-SAN CHU MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 HILLHURST AVE
LOS ANGELES CA
90027-5516
US

IV. Provider business mailing address

1530 HILLHURST AVE
LOS ANGELES CA
90027-5516
US

V. Phone/Fax

Practice location:
  • Phone: 323-644-3888
  • Fax:
Mailing address:
  • Phone: 323-644-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number527595
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF10078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: