Healthcare Provider Details

I. General information

NPI: 1568635332
Provider Name (Legal Business Name): YONG CHA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 S FLOYD ST
LOUISVILLE KY
40202-1840
US

IV. Provider business mailing address

1930 BISHOP LN SUITE 1017
LOUISVILLE KY
40218-1921
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-4555
  • Fax: 502-629-4599
Mailing address:
  • Phone: 502-272-5754
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number46430
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: