Provider Demographics
NPI:1871564435
Name:CHIA, JENNY LIEU (MD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LIEU
Last Name:CHIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 50716
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89016-0716
Mailing Address - Country:US
Mailing Address - Phone:702-614-0850
Mailing Address - Fax:702-614-0798
Practice Address - Street 1:2789 SUNRIDGE HEIGHTS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5053
Practice Address - Country:US
Practice Address - Phone:702-614-0850
Practice Address - Fax:702-614-0798
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV10588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500720Medicaid
NV100500721Medicaid
NVH92112Medicare UPIN
NV100500720Medicaid