Provider Demographics
NPI:1326184250
Name:DAVID J. CHAO MD, INC
Entity Type:Organization
Organization Name:DAVID J. CHAO MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-627-4763
Mailing Address - Street 1:8901 ACTIVITY ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126
Mailing Address - Country:US
Mailing Address - Phone:844-627-4763
Mailing Address - Fax:760-635-7801
Practice Address - Street 1:8901 ACTIVITY ROAD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126
Practice Address - Country:US
Practice Address - Phone:844-627-4763
Practice Address - Fax:760-635-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78677207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W17163OtherMEDICARE GROUP NUMBER
W17163OtherMEDICARE PTAN
WG78677DOtherMEDICARE PROVIDER ID
CAF80722Medicare UPIN