Healthcare Provider Details

I. General information

NPI: 1073547824
Provider Name (Legal Business Name): THA CHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E BARSTOW AVE STE 118
FRESNO CA
93710-5023
US

IV. Provider business mailing address

125 E BARSTOW AVE STE 118
FRESNO CA
93710-5023
US

V. Phone/Fax

Practice location:
  • Phone: 559-486-5290
  • Fax: 559-486-5630
Mailing address:
  • Phone: 559-486-5290
  • Fax: 559-486-5630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA84894
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA84894
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA84894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: