Healthcare Provider Details

I. General information

NPI: 1477014694
Provider Name (Legal Business Name): DAVID CHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 WAYNE AVE
DAYTON OH
45420-1893
US

IV. Provider business mailing address

2451 WAYNE AVE
DAYTON OH
45420-1893
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-7377
  • Fax:
Mailing address:
  • Phone: 937-208-7377
  • Fax: 937-208-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.144083
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.144083
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: