Healthcare Provider Details

I. General information

NPI: 1215219365
Provider Name (Legal Business Name): JESSICA MAY LUM LAU PPCNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 WHITTIER BLVD SUITE 250
WHITTIER CA
90603-2347
US

IV. Provider business mailing address

15725 WHITTIER BLVD SUITE 250
WHITTIER CA
90603-2347
US

V. Phone/Fax

Practice location:
  • Phone: 562-947-9399
  • Fax:
Mailing address:
  • Phone: 562-947-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382238
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number21799
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number644977
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: