Provider Demographics
NPI:1780701888
Name:HO, QUYEN JASY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MISS
First Name:QUYEN
Middle Name:JASY
Last Name:HO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DEWEY AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3877
Mailing Address - Country:US
Mailing Address - Phone:714-658-9269
Mailing Address - Fax:
Practice Address - Street 1:767 N HILL ST STE 200A-B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2343
Practice Address - Country:US
Practice Address - Phone:213-808-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily