Provider Demographics
NPI:1154649796
Name:DAVID D. CHI, M.D., F.A.C.S., A MEDICAL CORP.
Entity Type:Organization
Organization Name:DAVID D. CHI, M.D., F.A.C.S., A MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-497-7785
Mailing Address - Street 1:555 MARIN STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4105
Mailing Address - Country:US
Mailing Address - Phone:805-497-7785
Mailing Address - Fax:805-497-7728
Practice Address - Street 1:555 MARIN STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4105
Practice Address - Country:US
Practice Address - Phone:805-497-7785
Practice Address - Fax:805-497-7728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84570208600000X, 2086X0206X
2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA898BMedicare PIN
CADA898AMedicare UPIN