Healthcare Provider Details

I. General information

NPI: 1720218175
Provider Name (Legal Business Name): ERIC K CHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121ST HOSPITAL UNIT 15244 BOX 702
APO AP
96205-5244
US

IV. Provider business mailing address

121ST CSH, UNIT 15244 BOX 702
APO AP
96205-5244
US

V. Phone/Fax

Practice location:
  • Phone: 425-956-3313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN44450
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: