Provider Demographics
NPI:1487274759
Name:SUMULONG, CHELSEA ELIZABETH LIU (PA-C)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ELIZABETH LIU
Last Name:SUMULONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 BOUNTY DR APT 3404
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2665
Mailing Address - Country:US
Mailing Address - Phone:808-371-7766
Mailing Address - Fax:
Practice Address - Street 1:3338 17TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-7213
Practice Address - Country:US
Practice Address - Phone:415-390-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA59377363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant