Provider Demographics
NPI:1093016735
Name:HU, CHARLOTTE LING CHIEN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:LING CHIEN
Last Name:HU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12403 VENTURA CT STE A
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2470
Mailing Address - Country:US
Mailing Address - Phone:818-900-6007
Mailing Address - Fax:
Practice Address - Street 1:12403 VENTURA CT STE A
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2470
Practice Address - Country:US
Practice Address - Phone:818-900-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21306363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEN475AMedicare PIN