Healthcare Provider Details

I. General information

NPI: 1841262342
Provider Name (Legal Business Name): CHAE GREG HA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 NE CUSHING DR
BEND OR
97701-3730
US

IV. Provider business mailing address

1303 NE CUSHING DR SUITE 100
BEND OR
97701-3887
US

V. Phone/Fax

Practice location:
  • Phone: 541-330-8226
  • Fax:
Mailing address:
  • Phone: 541-388-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD25174
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier232449
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: