Provider Demographics
NPI:1952691883
Name:ROMAN B CHAM MD INC
Entity Type:Organization
Organization Name:ROMAN B CHAM MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:BORIS
Authorized Official - Last Name:CHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-668-0900
Mailing Address - Street 1:7339 EL CAJON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7435
Mailing Address - Country:US
Mailing Address - Phone:619-668-0900
Mailing Address - Fax:619-668-0265
Practice Address - Street 1:7339 EL CAJON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7435
Practice Address - Country:US
Practice Address - Phone:619-668-0900
Practice Address - Fax:619-668-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37068Medicare UPIN
CA5392790001Medicare NSC