Provider Demographics
NPI:1871636464
Name:CHAO, PEI H (MD)
Entity Type:Individual
Prefix:DR
First Name:PEI
Middle Name:H
Last Name:CHAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:CHAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M D
Mailing Address - Street 1:PO BOX 63202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-0202
Mailing Address - Country:US
Mailing Address - Phone:323-268-5598
Mailing Address - Fax:323-268-8892
Practice Address - Street 1:4082 WHITTIER BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2559
Practice Address - Country:US
Practice Address - Phone:323-268-5598
Practice Address - Fax:323-268-8892
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ81352ZMedicaid
CAZZZ81352ZMedicaid
CAWA048560EMedicare ID - Type Unspecified