Healthcare Provider Details

I. General information

NPI: 1679742472
Provider Name (Legal Business Name): EDWARD KING CHAW DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR EDWARDS BUILDING, ROOM R107, MC 5336
PALO ALTO CA
94305-2200
US

IV. Provider business mailing address

751 S BASCOM AVE REHABILITATION CENTER
SAN JOSE CA
95128-2604
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-1410
  • Fax: 650-498-7546
Mailing address:
  • Phone: 408-885-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A10144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: