MEDICARE: DAVID D. CHI, M.D., F.A.C.S., A MEDICAL CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086X0206X	Surgical Oncology Physician	G84570	CA
2	208600000X	Surgery Physician	G84570	CA
3	2086X0206X	Surgical Oncology Physician

General Provider Information

NPI Number	:	1154649796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID D. CHI, M.D., F.A.C.S., A MEDICAL CORP.

Provider Business Mailing Address
First Line	:	555 MARIN STREET
Second Line	:	SUITE 210
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-4105
Country	:	US
Telephone Number	:	805-497-7785
Fax Number	:	805-497-7728

Provider Business Practice Location Address
First Line	:	555 MARIN STREET
Second Line	:	SUITE 210
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-4105
Country	:	US
Telephone Number	:	805-497-7785
Fax Number	:	805-497-7728

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. DAVID D. CHI
Credential	:	M.D.
Telephone Number	:	805-497-7785

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	07/20/2011

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