1801898713 NPI number — CHIUSHEUE SHERRY PENG NURSE PRACTITIONER

Table of content: CHIUSHEUE SHERRY PENG NURSE PRACTITIONER (NPI 1801898713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801898713 NPI number — CHIUSHEUE SHERRY PENG NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENG
Provider First Name:
CHIUSHEUE
Provider Middle Name:
SHERRY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PENG
Provider Other First Name:
SHERRY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NURSE PRACTITTIONER
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1801898713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4040 VIA MARISOL
Provider Second Line Business Mailing Address:
#321
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90042-5154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-224-6982
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 SAN PABLO ST
Provider Second Line Business Practice Location Address:
CARDIACTHORACIC SUGERY UNIT
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-5313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-442-8869
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  NP15174 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)