Provider Demographics
NPI:1912025214
Name:TIM K CHA MD NEUROLOGY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:TIM K CHA MD NEUROLOGY MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-372-2821
Mailing Address - Street 1:3440 LOMITA BLVD
Mailing Address - Street 2:SUITE #138
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4801
Mailing Address - Country:US
Mailing Address - Phone:310-372-2821
Mailing Address - Fax:310-372-9358
Practice Address - Street 1:3440 LOMITA BLVD
Practice Address - Street 2:SUITE #138
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4801
Practice Address - Country:US
Practice Address - Phone:310-372-2821
Practice Address - Fax:310-372-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA521972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52197OtherCA LICENSE NUMBER
CA1538267901OtherNPI
CA1538267901OtherNPI