Provider Demographics
NPI:1003977083
Name:RICHARD A.K. CHAFFOO, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RICHARD A.K. CHAFFOO, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALBERT KIM
Authorized Official - Last Name:CHAFFOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-623-6333
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1224
Mailing Address - Country:US
Mailing Address - Phone:858-623-6333
Mailing Address - Fax:858-623-0204
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-623-6333
Practice Address - Fax:858-623-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54383208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52708Medicare UPIN