Provider Demographics
NPI:1326336264
Name:CHIN, JULIA AYE
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:AYE
Last Name:CHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AYE
Other - Middle Name:AYE
Other - Last Name:NGWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10418 VALLEY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-3600
Mailing Address - Country:US
Mailing Address - Phone:323-725-8751
Mailing Address - Fax:
Practice Address - Street 1:10418 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3600
Practice Address - Country:US
Practice Address - Phone:626-242-7061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA127511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program