---
type: id
category: id
person: Nichol Li
date: 2023-11-22
source: nichol_birth_cert_2023.pdf
---

# Certificate of Live Birth — Nichol Li

**State of California, County of Los Angeles, Department of Public Health**

**State File Number:** 1202319076052

## Child Information

| Field | Value |
|-------|-------|
| 1A. Name of Child - First | NICHOL |
| 1B. Middle | — |
| 1C. Last | LI |
| 2. Sex | MALE |
| 3A. This Birth: Single, Twin, etc. | SINGLE |
| 3B. If Multiple, This Child 1st, 2nd, etc. | — |
| 4A. Date of Birth - MM/DD/CCY | 11/22/2023 |
| 4B. Hour - 24 Hour Clock Time | 2345 |

## Place of Birth

| Field | Value |
|-------|-------|
| 5A. Place of Birth - Name of Hospital or Facility | USC ARCADIA HOSPITAL |
| 5B. Street Address - Street and Number, or Location | 300 W. HUNTINGTON DR |
| 5C. City | ARCADIA |
| 5D. County | LOS ANGELES |

## Parent 1 (Father)

| Field | Value |
|-------|-------|
| 6A. Name of Parent - First | CHENG |
| 6B. Middle | — |
| 6C. Last - Birth Name | LI |
| 7. Birthplace - State/Country | CHINA |
| 8. Date of Birth | 06/16/1987 |
| Relationship to Child | FATHER |

## Parent 2 (Mother)

| Field | Value |
|-------|-------|
| 9A. Name of Parent - First | XIANG |
| 9B. Middle | — |
| 9C. Last - Birth Name | ZHANG |
| 10. Birthplace - State/Country | CHINA |
| 11. Date of Birth | 03/16/1990 |
| Relationship to Child | MOTHER |

## Informant and Birth Certification

| Field | Value |
|-------|-------|
| 12A. Parent or Other Informant - Signature | CHENG LI |
| 12B. Relationship to Child | FATHER |
| 12C. Date Signed | 11/23/2023 |
| — | XIANG ZHANG |
| Relationship | MOTHER |
| Date Signed | 11/23/2023 |
| 13A. Attendant/Certifier - Signature and Degree or Title | BESSIE NHAN, BIRTH. REG. |
| 13B. Number | A64425 |
| 13C. Date Signed | 11/24/2023 |
| 13D. Typed Name, Title and Mailing Address of Attendant | CINDY HUANG CHOU, MD, 207 S SANTA ANITA ST STE 335, SAN GABRIEL, CA 91776 |
| 14. Typed Name and Title of Certifier if Other Than Attendant | BESSIE NHAN, BIRTH. REG. |
| 16. Local Registrar - Signature | MUNTU DAVIS MD |
| 17. Date Accepted for Registration | 11/27/2023 |

## Certification

**CERTIFIED COPY OF VITAL RECORD** — State of California, County of Los Angeles

This is a true certified copy of the record filed in the County of Los Angeles Department of Public Health if it bears the Registrar's signature in purple ink.

- Health Officer and Registrar: VG, MD
- Date Issued: NOV 27, 2023
- Barcode: *004097660*

Seal of the County of Los Angeles and State of California present.

"This copy not valid unless prepared on engraved border displaying seal and signature of Registrar."
"ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE"