Healthcare Provider Details

I. General information

NPI: 1023470226
Provider Name (Legal Business Name): THUY XUAN HUA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2016
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S RAYMOND AVE UNIT 240
PASADENA CA
91105
US

IV. Provider business mailing address

630 S RAYMOND AVE UNIT 240
PASADENA CA
91105-3283
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-9920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: