Provider Demographics
NPI:1639271505
Name:CHAFFOO, RICHARD AK (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:AK
Last Name:CHAFFOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9850 GENESEE AVE STE 480
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1213
Mailing Address - Country:US
Mailing Address - Phone:858-623-6333
Mailing Address - Fax:858-623-0204
Practice Address - Street 1:9850 GENESEE AVE STE 480
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-623-6333
Practice Address - Fax:858-623-0204
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG54363208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52708Medicare UPIN
CAW16950Medicare ID - Type Unspecified