Healthcare Provider Details

I. General information

NPI: 1164800488
Provider Name (Legal Business Name): CYNTHIA W CHAO D O A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 04/20/2024
Certification Date: 04/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10861 CHERRY ST STE 109
LOS ALAMITOS CA
90720-5400
US

IV. Provider business mailing address

1540 W AVERILL PARK DR
SAN PEDRO CA
90732-3924
US

V. Phone/Fax

Practice location:
  • Phone: 562-961-3137
  • Fax: 562-961-3196
Mailing address:
  • Phone: 562-208-6642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number20A7343
License Number StateCA

VIII. Authorized Official

Name: MISS CYNTHIA W CHAO
Title or Position: DOCTOR
Credential: D.O.
Phone: 562-961-3137