Provider Demographics
NPI:1013953108
Name:CHAO, KAREN H (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:H
Last Name:CHAO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S DEL MAR AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1345
Mailing Address - Country:US
Mailing Address - Phone:626-287-0401
Mailing Address - Fax:626-287-1457
Practice Address - Street 1:121 S DEL MAR AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1345
Practice Address - Country:US
Practice Address - Phone:626-287-0401
Practice Address - Fax:626-287-1457
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10301 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0103010Medicaid
CASD0103010Medicaid
CAU60101Medicare UPIN