Healthcare Provider Details

I. General information

NPI: 1881746428
Provider Name (Legal Business Name): DAVID D. CHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MARIN STREET SUITE 210
THOUSAND OAKS CA
91360-4105
US

IV. Provider business mailing address

555 MARIN STREET SUITE 210
THOUSAND OAKS CA
91360-4150
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-7785
  • Fax: 805-497-7728
Mailing address:
  • Phone: 805-497-7785
  • Fax: 805-497-7728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG84570
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberG84570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: