Provider Demographics
NPI:1417209859
Name:SHIU, CHANH (NP)
Entity Type:Individual
Prefix:
First Name:CHANH
Middle Name:
Last Name:SHIU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 AERO JET AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3400 AERO JET AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2803
Practice Address - Country:US
Practice Address - Phone:626-111-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2022-01-12
Deactivation Date:2015-06-29
Deactivation Code:
Reactivation Date:2017-07-28
Provider Licenses
StateLicense IDTaxonomies
CA95018827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily