Provider Demographics
NPI:1649324260
Name:CHAO, JOHN (DPT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:CHAO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 PACIFIC AVE
Mailing Address - Street 2:# 115
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4163
Mailing Address - Country:US
Mailing Address - Phone:214-529-2682
Mailing Address - Fax:
Practice Address - Street 1:1821 WILSHIRE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403
Practice Address - Country:US
Practice Address - Phone:310-828-2188
Practice Address - Fax:310-829-1379
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16381Medicare ID - Type Unspecified