Healthcare Provider Details

I. General information

NPI: 1710098165
Provider Name (Legal Business Name): ROBERT YOUNG CHA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 E EDINGER AVE
SANTA ANA CA
92705-5001
US

IV. Provider business mailing address

1151 E LITTLE DR
PLACENTIA CA
92870-5268
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-8904
  • Fax:
Mailing address:
  • Phone: 714-381-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: