Provider Demographics
NPI:1922422526
Name:LAWRENCE L. CHAO, MD A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:LAWRENCE L. CHAO, MD A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-333-3302
Mailing Address - Street 1:2645 OCEAN AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1633
Mailing Address - Country:US
Mailing Address - Phone:415-333-3302
Mailing Address - Fax:415-692-8688
Practice Address - Street 1:2645 OCEAN AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1633
Practice Address - Country:US
Practice Address - Phone:415-333-3302
Practice Address - Fax:415-692-8688
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWRENCE L. CHAO, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55511261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG79217Medicare UPIN