Healthcare Provider Details

I. General information

NPI: 1568156131
Provider Name (Legal Business Name): SUNNY CHEN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N KUKUI ST STE 102A
HONOLULU HI
96817-3921
US

IV. Provider business mailing address

245 N KUKUI ST STE 102A
HONOLULU HI
96817-3921
US

V. Phone/Fax

Practice location:
  • Phone: 808-452-1439
  • Fax:
Mailing address:
  • Phone: 949-302-6920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR174543
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: