Healthcare Provider Details

I. General information

NPI: 1639000656
Provider Name (Legal Business Name): JEONGHWA CHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 444 BOX 998
APO AP
96297-0010
US

IV. Provider business mailing address

PSC 444 BOX 998
APO AP
96297-0010
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-5136
  • Fax:
Mailing address:
  • Phone: 315-737-5136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number505821
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: