Healthcare Provider Details

I. General information

NPI: 1265061600
Provider Name (Legal Business Name): BRENT CHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E CHURCH ST STE 301
SANTA MARIA CA
93454-5915
US

IV. Provider business mailing address

1325 E CHURCH ST STE 301
SANTA MARIA CA
93454-5915
US

V. Phone/Fax

Practice location:
  • Phone: 805-349-9393
  • Fax: 805-614-7929
Mailing address:
  • Phone: 805-349-9393
  • Fax: 805-614-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA189790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: