Provider Demographics
NPI:1730290289
Name:CHAO, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:CHAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:JEE WEI
Other - Last Name:CHAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8901 ACTIVITY RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4427
Mailing Address - Country:US
Mailing Address - Phone:844-627-4763
Mailing Address - Fax:858-571-1933
Practice Address - Street 1:8901 ACTIVITY RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4427
Practice Address - Country:US
Practice Address - Phone:844-627-4763
Practice Address - Fax:858-571-1933
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78677207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
W17163OtherMEDICARE PTAN
WG78677DOtherMEDICARE PROVIDER ID
W17163OtherMEDICARE GROUP NUMBER
WG78677DOtherMEDICARE PROVIDER ID