Provider Demographics
NPI:1891144135
Name:CHA, KAO
Entity Type:Individual
Prefix:
First Name:KAO
Middle Name:
Last Name:CHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43961 KALIFORNSKY BEACH RD STE C
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8276
Mailing Address - Country:US
Mailing Address - Phone:907-398-8431
Mailing Address - Fax:907-260-1177
Practice Address - Street 1:3307 BONIFACE PKWY SPC 135
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3760
Practice Address - Country:US
Practice Address - Phone:907-884-3546
Practice Address - Fax:907-332-7805
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator