Provider Demographics
NPI:1336196708
Name:VISOTH CHHIAP, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:VISOTH CHHIAP, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VISOTH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHHIAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-779-1772
Mailing Address - Street 1:18550 DE PAUL DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-2911
Mailing Address - Country:US
Mailing Address - Phone:408-779-1772
Mailing Address - Fax:408-779-1050
Practice Address - Street 1:18550 DE PAUL DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-2911
Practice Address - Country:US
Practice Address - Phone:408-779-1772
Practice Address - Fax:408-779-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66992207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTIN