Provider Demographics
NPI:1972698793
Name:CHHAYA, SAMIR AMIT (MD)
Entity Type:Individual
Prefix:MR
First Name:SAMIR
Middle Name:AMIT
Last Name:CHHAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 740608
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-0608
Mailing Address - Country:US
Mailing Address - Phone:469-317-9900
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-564-7866
Practice Address - Fax:972-564-6290
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM92102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169855702Medicaid
TX169855701OtherCIDC
TXP00170713Medicare PIN
TX169855702Medicaid