Provider Demographics
NPI:1225133465
Name:CHAE, CHUL H (MD)
Entity Type:Individual
Prefix:
First Name:CHUL
Middle Name:H
Last Name:CHAE
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 1:400 N PEPPER AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1801
Mailing Address - Country:US
Mailing Address - Phone:909-580-1520
Mailing Address - Fax:909-580-1561
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-1520
Practice Address - Fax:909-580-1561
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA721812085N0904X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA72181OtherSTATE LICENSE
CA00A721810Medicaid
CAA72181OtherSTATE LICENSE
CAP00229798Medicare PIN
CAH59352Medicare UPIN
CA00A721811Medicare PIN
CABF005ZMedicare PIN
CABF005YMedicare PIN