Provider Demographics
NPI:1255534871
Name:CHIM, HA (MD)
Entity type:Individual
Prefix:DR
First Name:HA
Middle Name:
Last Name:CHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JIMMY
Other - Middle Name:HA
Other - Last Name:CHIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1111 EAST MCDOWELL ROAD, BUILDING A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006
Mailing Address - Country:US
Mailing Address - Phone:602-839-4242
Mailing Address - Fax:602-839-3411
Practice Address - Street 1:1111 EAST MCDOWELL ROAD, BUILDING A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-839-4242
Practice Address - Fax:602-839-3411
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND145622086S0122X
AZ712702086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery