Provider Demographics
NPI:1477378768
Name:CHOUANG, QIONGQIONG JENNY (NP)
Entity type:Individual
Prefix:
First Name:QIONGQIONG
Middle Name:JENNY
Last Name:CHOUANG
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 INDIANAPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9281
Mailing Address - Country:US
Mailing Address - Phone:559-320-6878
Mailing Address - Fax:
Practice Address - Street 1:6110 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-2009
Practice Address - Country:US
Practice Address - Phone:559-320-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033070363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health