Provider Demographics
NPI:1164887279
Name:CHUA, HAIDEE
Entity Type:Individual
Prefix:
First Name:HAIDEE
Middle Name:
Last Name:CHUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9205 LOYOLA WAY
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4622
Mailing Address - Country:US
Mailing Address - Phone:562-841-9146
Mailing Address - Fax:
Practice Address - Street 1:9205 LOYOLA WAY
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4622
Practice Address - Country:US
Practice Address - Phone:562-841-9146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 227883164W00000X
AKNURP6821164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherSSN