=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528371655
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. HANH MY CHU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2010
-----------------------------------------------------
Last Update Date | 01/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5565 GROSSMONT CENTER DR BLDG 2, STE 1
-----------------------------------------------------
City | LA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91942-3020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-567-1550
-----------------------------------------------------
Fax | 619-567-1545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6367 ALVARADO CT STE 300
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92120-4916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-255-5903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 19157
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------