Provider Demographics
NPI:1245518414
Name:MAA CHIP, FHARAK (MD)
Entity type:Individual
Prefix:
First Name:FHARAK
Middle Name:
Last Name:MAA CHIP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4225 EXECUTIVE SQ STE 450
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-8411
Mailing Address - Country:US
Mailing Address - Phone:858-810-8025
Mailing Address - Fax:858-268-1911
Practice Address - Street 1:655 EUCLID AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2957
Practice Address - Country:US
Practice Address - Phone:619-475-4900
Practice Address - Fax:619-475-8373
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA117604207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA124198OtherNO. CALIFORNIA PTAN
CACB216371OtherSO. CALIFORNIA PTAN
CAA117604OtherCA LICENSE