Healthcare Provider Details

I. General information

NPI: 1124024773
Provider Name (Legal Business Name): JAI C CHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4941
US

IV. Provider business mailing address

1425 BLUE HERON RD
VIRGINIA BEACH VA
23454-1714
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-6118
  • Fax: 757-312-6235
Mailing address:
  • Phone: 757-481-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101026695
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: