MEDICARE: DR. KIM CHAU RAHARJA O.D.

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	152W00000X	Optometrist	OPT002319	GA

General Provider Information

NPI Number	:	1720094527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIM CHAU RAHARJA O.D.

Provider Business Mailing Address
First Line	:	1841 CHAMBLEE TUCKER RD STE 1-4B
Second Line	:
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-2784
Country	:	US
Telephone Number	:	770-409-8977
Fax Number	:	404-521-4677

Provider Business Practice Location Address
First Line	:	1841 CHAMBLEE TUCKER RD STE 1-4B
Second Line	:
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-2784
Country	:	US
Telephone Number	:	770-409-8977
Fax Number	:	404-521-4776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	02/06/2026

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