Provider Demographics
NPI:1548623689
Name:CHIANG, TRISHA (NP)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:CHIANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:TSUNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:783 GATUN ST UNIT 212
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-1347
Mailing Address - Country:US
Mailing Address - Phone:626-222-0776
Mailing Address - Fax:
Practice Address - Street 1:1031 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-3505
Practice Address - Country:US
Practice Address - Phone:213-740-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily