Provider Demographics
NPI:1831791235
Name:CHAN, NAOMI CHIUYEE (PMHNP-BC, RN)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:CHIUYEE
Last Name:CHAN
Suffix:
Gender:F
Credentials:PMHNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 8TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6526
Mailing Address - Country:US
Mailing Address - Phone:510-735-3900
Mailing Address - Fax:
Practice Address - Street 1:310 8TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6526
Practice Address - Country:US
Practice Address - Phone:510-735-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95225060163W00000X
CA95016070363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse