Healthcare Provider Details

I. General information

NPI: 1245764547
Provider Name (Legal Business Name): YMY CHIEU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 NE SAINT LUKES BLVD STE 200
LEES SUMMIT MO
64086-6001
US

IV. Provider business mailing address

901 E. 104TH ST. MAILSTOP 400N
KANSAS CITY MO
64131
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-5100
  • Fax:
Mailing address:
  • Phone: 816-502-7104
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77616
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017010993
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: