Provider Demographics
NPI:1376245464
Name:SUTHERLAND, CHAE AUNA
Entity Type:Individual
Prefix:
First Name:CHAE
Middle Name:AUNA
Last Name:SUTHERLAND
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 1:6377 GARDEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-6633
Mailing Address - Country:US
Mailing Address - Phone:307-315-4405
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLAZA, INTERNAL MEDICINE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7419
Practice Address - Country:US
Practice Address - Phone:310-825-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program