Provider Demographics
NPI:1780858605
Name:SOON M. CHA MD, INC
Entity Type:Organization
Organization Name:SOON M. CHA MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOON
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-368-6020
Mailing Address - Street 1:1058 S VERMONT AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2731
Mailing Address - Country:US
Mailing Address - Phone:213-368-6020
Mailing Address - Fax:
Practice Address - Street 1:1058 S VERMONT AVE STE 204
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2731
Practice Address - Country:US
Practice Address - Phone:213-368-6020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39746261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A397460Medicaid
CAA39746Medicare UPIN
CA00A397460Medicaid