Provider Demographics
NPI:1568204147
Name:CHUA, JENNIFER ANN SY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JENNIFER ANN
Middle Name:SY
Last Name:CHUA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S OXFORD AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5151
Mailing Address - Country:US
Mailing Address - Phone:424-378-2484
Mailing Address - Fax:
Practice Address - Street 1:102 S OXFORD AVE APT 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5151
Practice Address - Country:US
Practice Address - Phone:424-378-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025750363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care