Healthcare Provider Details

I. General information

NPI: 1164611695
Provider Name (Legal Business Name): JASON HAN CHUA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ 3304
LOS ANGELES CA
90095-7403
US

IV. Provider business mailing address

1951 MALCOLM AVENUE #101
LOS ANGELES CA
90025
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-8655
  • Fax:
Mailing address:
  • Phone: 310-470-6356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA99735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: