Healthcare Provider Details

I. General information

NPI: 1942526280
Provider Name (Legal Business Name): JENNY LYNN CHUA-TUAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

4647 ZION AVE DEPARTMENT OF EMERGENCY MEDICINE
SAN DIEGO CA
92120-2507
US

V. Phone/Fax

Practice location:
  • Phone: 619-952-4642
  • Fax:
Mailing address:
  • Phone: 800-290-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0055688
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberAI44521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: