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General NPI Number Information
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NPI Number | 1487274759
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Entity Type | Individual
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Provider Name | CHELSEA ELIZABETH LIU SUMULONG PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 3338 17TH ST STE 100
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-7213
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Country | US
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Telephone | 415-390-0099
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Fax |
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Provider Business Mailing Address
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Address Line | 734 BOUNTY DR APT 3404
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City | FOSTER CITY
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State | CA
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Zip | 94404-2665
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Country | US
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Telephone | 808-371-7766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 59377
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License Number State | CA
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