Provider Demographics
NPI:1376067280
Name:HAO, SELENA KWAN (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:SELENA
Middle Name:KWAN
Last Name:HAO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 E CALAVERAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5491
Mailing Address - Country:US
Mailing Address - Phone:408-945-2900
Mailing Address - Fax:
Practice Address - Street 1:770 E CALAVERAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5491
Practice Address - Country:US
Practice Address - Phone:408-945-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA845064163W00000X
CA95007048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA546938OtherBOARD OF REGISTERED NURSING PUBLIC HEALTH NURSE LICENSE
CA845064OtherBOARD OF REGISTERED NURSING RN LICENSE
CA95007048OtherBOARD OF REGISTERED NURSING NP LICENSE