Individual
CHHAY TEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1798 N GAREY AVE, POMONA, CA 91767-2918
(909) 865-9500
Mailing address
16941 BACKWATER LN, FONTANA, CA 92336-2197
(909) 908-6570
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95063723
CA
Other
Enumeration date
02/21/2025
Last updated
02/21/2025
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