Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | G83480 | CA |
NPI | 1073576807 |
---|---|
Provider Name | Joanna Chau Jane Chen |
First Address | Oklahoma City, OK 73172-0300 |
Second Address | Newport Beach, CA 92658-6100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 12/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G834800 | (05) | CA |
00G834800 | BLUE SHIELD (01) | CA |
00G834800670 | (05) | CA |
G34090 | (02) | CA |