Provider Demographics
NPI:1306014568
Name:CHA, ANTHONY INCHOL (DDS,MS,MS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:INCHOL
Last Name:CHA
Suffix:
Gender:M
Credentials:DDS,MS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18909 SOLEDAD CANYON RD STE G
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3385
Mailing Address - Country:US
Mailing Address - Phone:661-251-7107
Mailing Address - Fax:661-251-8850
Practice Address - Street 1:18909 SOLEDAD CANYON RD STE G
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3385
Practice Address - Country:US
Practice Address - Phone:661-251-7107
Practice Address - Fax:661-251-8850
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA461701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics