Healthcare Provider Details

I. General information

NPI: 1750396263
Provider Name (Legal Business Name): DENNIS J. CHIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE RM 22-315
LOS ANGELES CA
90095
US

IV. Provider business mailing address

10833 LE CONTE AVE RM 22-315
LOS ANGELES CA
90095-3075
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-2098
  • Fax:
Mailing address:
  • Phone: 310-206-2098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number257223
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMD23046
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number257223
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: