Healthcare Provider Details

I. General information

NPI: 1932514478
Provider Name (Legal Business Name): CHI W DAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 E RIVER RD
TUCSON AZ
85718-6526
US

IV. Provider business mailing address

2450 E RIVER RD
TUCSON AZ
85718-6526
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-7750
  • Fax:
Mailing address:
  • Phone: 520-795-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number58319
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6884
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number6884
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number28319
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: