Healthcare Provider Details

I. General information

NPI: 1548623689
Provider Name (Legal Business Name): TRISHA CHIANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISHA TSUNO NP

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 W JEFFERSON BLVD
LOS ANGELES CA
90089-3505
US

IV. Provider business mailing address

783 GATUN ST UNIT 212
SAN PEDRO CA
90731-1347
US

V. Phone/Fax

Practice location:
  • Phone: 213-740-9355
  • Fax:
Mailing address:
  • Phone: 626-222-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: