Healthcare Provider Details

I. General information

NPI: 1225309958
Provider Name (Legal Business Name): JIN CHAE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SEUNG CHAE

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 W ADAMS BLVD
LOS ANGELES CA
90007-1533
US

IV. Provider business mailing address

1665 W ADAMS BLVD
LOS ANGELES CA
90007-1533
US

V. Phone/Fax

Practice location:
  • Phone: 323-731-3534
  • Fax: 323-731-5618
Mailing address:
  • Phone: 323-731-3534
  • Fax: 323-731-5618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5813
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: