Individual provider Active NPI

Ivy Yen Chua, MSN, FNP

  • Family Nurse Practitioner
  • San Francisco, CA
National Provider Identifier
1053568402
Registry record updated Jun 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
23703 Issued in CA
Practice address
2 Embarcadero Ctr
San Francisco, CA 94111-3823
Phone
(415) 578-3100
NPI assigned
Aug 27, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Registered Nurse 163WC1500X 73423 CA
Family Nurse Practitioner 363LF0000X C-APN.0100456-C-NP CO
Family Nurse Practitioner 363LF0000X 1049928 TX
Family Nurse Practitioner 363LF0000X 23703 CA Primary

Addresses

Primary practice location

2 Embarcadero Ctr
San Francisco, CA 94111-3823

Mailing address

1 Embarcadero Ctr Ste 1900
San Francisco, CA 94111-3723

Other names 1

  • Mrs. Ivy Yen Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210604002404 CA Practitioner - Nurse Practitioner 8729357330

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
23703CAMDClinical Social Worker
73423CAMDCommunity Health Registered Nurse
C-APN.0100456-C-NPCOMDFamily Nurse Practitioner
1049928TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Clarke Lew Medical Corp CurrentSince May 1, 2021 Accepting new patients

Locations

3535 W Commonwealth Ave
Fullerton, CA 92833
Phone (949) 243-7788

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22909/brand/1/csg/1/fhir/r4

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1053568402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EMBARCADERO CTR STE 1900",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941113723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 EMBARCADERO CTR",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941113823",
            "telephone_number": "415-578-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUA",
        "first_name": "IVY",
        "middle_name": "YEN",
        "name_prefix": "Mrs.",
        "credential": "MSN, FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-27",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "CA",
            "license": "73423",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "C-APN.0100456-C-NP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1049928",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "23703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IVY",
            "last_name": "YEN",
            "prefix": "MRS.",
            "credential": "MSN, FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.