Healthcare Provider Details

I. General information

NPI: 1760656276
Provider Name (Legal Business Name): STEPHANIE CHEN CHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13222 BLOOMFIELD AVE
NORWALK CA
90650-3249
US

IV. Provider business mailing address

PO BOX 2757
ORANGE CA
92859-0757
US

V. Phone/Fax

Practice location:
  • Phone: 562-863-4763
  • Fax: 562-207-9721
Mailing address:
  • Phone: 714-973-2650
  • Fax: 714-973-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA111403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: