Provider Demographics
NPI:1922341783
Name:JISUN CHA MD
Entity Type:Organization
Organization Name:JISUN CHA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JISUN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-567-0330
Mailing Address - Street 1:460 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2919
Mailing Address - Country:US
Mailing Address - Phone:201-567-0330
Mailing Address - Fax:
Practice Address - Street 1:460 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07632-2919
Practice Address - Country:US
Practice Address - Phone:201-567-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-30
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09071200207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty