Healthcare Provider Details

I. General information

NPI: 1528358900
Provider Name (Legal Business Name): ADAM PRENTICE CHAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 STOCKTON BLVD
SACRAMENTO CA
95817-2215
US

IV. Provider business mailing address

2425 STOCKTON BLVD
SACRAMENTO CA
95817-2215
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-2105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberA149520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: