=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063104248
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THUYLIEN CHAU FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2023
-----------------------------------------------------
Last Update Date | 05/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14023 PARAMOUNT BLVD
-----------------------------------------------------
City | PARAMOUNT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90723-2605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-286-6815
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20599 PEACEFUL WOODS DR
-----------------------------------------------------
City | DIAMOND BAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91789-4020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-401-9687
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 95025314
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------