Healthcare Provider Details

I. General information

NPI: 1861697427
Provider Name (Legal Business Name): CLARA CHAE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 BROCKTON AVE STE 201
RIVERSIDE CA
92506-0104
US

IV. Provider business mailing address

6250 CLAY ST
RIVERSIDE CA
92509-6005
US

V. Phone/Fax

Practice location:
  • Phone: 951-585-1800
  • Fax: 951-585-1801
Mailing address:
  • Phone: 951-360-5265
  • Fax: 951-360-6276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35095607
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number128817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: