Healthcare Provider Details

I. General information

NPI: 1518129980
Provider Name (Legal Business Name): SAMANTHA CHAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W 3RD ST SUITE 206
LOS ANGELES CA
90020-3450
US

IV. Provider business mailing address

4220 W 3RD ST SUITE 206
LOS ANGELES CA
90020-3450
US

V. Phone/Fax

Practice location:
  • Phone: 213-380-8800
  • Fax: 213-381-7474
Mailing address:
  • Phone: 213-380-8800
  • Fax: 213-381-7474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35091136
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME108130
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberN3545
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA118261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: