Provider Demographics
NPI:1073547824
Name:CHA, THA (MD)
Entity Type:Individual
Prefix:DR
First Name:THA
Middle Name:
Last Name:CHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E BARSTOW AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5023
Mailing Address - Country:US
Mailing Address - Phone:559-486-5290
Mailing Address - Fax:559-486-5630
Practice Address - Street 1:125 E BARSTOW AVE STE 118
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5023
Practice Address - Country:US
Practice Address - Phone:559-486-5290
Practice Address - Fax:559-486-5630
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84894207R00000X, 207RG0300X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A848940Medicare ID - Type Unspecified
I46319Medicare UPIN