Provider Demographics
NPI:1750756011
Name:CHIA, MOON YUEN
Entity type:Individual
Prefix:
First Name:MOON YUEN
Middle Name:
Last Name:CHIA
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 1:46280 BRIAR PL
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-6866
Mailing Address - Country:US
Mailing Address - Phone:510-490-7311
Mailing Address - Fax:
Practice Address - Street 1:46280 BRIAR PL
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-6866
Practice Address - Country:US
Practice Address - Phone:510-490-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-15-18688103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-15-18688OtherBCBA