Healthcare Provider Details

I. General information

NPI: 1922395516
Provider Name (Legal Business Name): MONICA CHAU QUYNH KIEU D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 ADMIRALTY WAY STE 718
MARINA DEL REY CA
90292-6634
US

IV. Provider business mailing address

PO BOX 3098
TORRANCE CA
90510-3098
US

V. Phone/Fax

Practice location:
  • Phone: 310-823-4444
  • Fax: 310-363-7085
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-898-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number20A15244
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number20A15244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: