Provider Demographics
NPI:1922789767
Name:CHA, ELIZA K
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:K
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 1:6220 105TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7017
Mailing Address - Country:US
Mailing Address - Phone:917-273-4572
Mailing Address - Fax:
Practice Address - Street 1:4020 LAKE WASHINGTON BLVD NE STE 301
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7862
Practice Address - Country:US
Practice Address - Phone:425-818-3949
Practice Address - Fax:425-300-6203
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA605-077-065374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide