Healthcare Provider Details

I. General information

NPI: 1750248233
Provider Name (Legal Business Name): DERRICK CHI
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W VALLEY BLVD
SAN GABRIEL CA
91776-5716
US

IV. Provider business mailing address

12016 SAN RIO ST
EL MONTE CA
91732-1234
US

V. Phone/Fax

Practice location:
  • Phone: 626-308-3800
  • Fax:
Mailing address:
  • Phone: 626-532-3851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95039827
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95349463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: