Provider Demographics
NPI:1245599869
Name:CHI, SIMON
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:CHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16311 BAMBOO ST
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-5510
Mailing Address - Country:US
Mailing Address - Phone:805-642-7033
Mailing Address - Fax:805-642-7201
Practice Address - Street 1:5810 RALSTON ST FL 2
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6010
Practice Address - Country:US
Practice Address - Phone:805-642-7033
Practice Address - Fax:805-642-7201
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17440000XOtherOTHER SERVICES