Provider Demographics
NPI:1639148539
Name:KAREN H. CHAO, O.D., INC.
Entity type:Organization
Organization Name:KAREN H. CHAO, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-287-0401
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10301T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0103010Medicaid
CASD0103010Medicaid
CAOP10301Medicare ID - Type Unspecified
CACE554AMedicare PIN