Provider Demographics
NPI:1710066337
Name:ERIC CHWA
Entity Type:Organization
Organization Name:ERIC CHWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-821-6411
Mailing Address - Street 1:632 W DUARTE RD
Mailing Address - Street 2:180
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7608
Mailing Address - Country:US
Mailing Address - Phone:626-821-6411
Mailing Address - Fax:626-821-6414
Practice Address - Street 1:632 W DUARTE RD
Practice Address - Street 2:180
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7608
Practice Address - Country:US
Practice Address - Phone:626-821-6411
Practice Address - Fax:626-821-6414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A495061Medicaid
CA00A495061Medicaid
CAA49506Medicare ID - Type Unspecified