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General NPI Number Information
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NPI Number | 1326918038
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Entity Type | Individual
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Provider Name | JUSTIN EVAN CHA
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Gender | Male
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 700 CHIEF EDDIE HOFFMAN HIGHWAY
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City | BETHEL
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State | AK
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Zip | 99559
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Country | US
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Telephone | 725-599-2183
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3427
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City | BETHEL
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State | AK
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Zip | 99559-3427
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Country | US
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Telephone | 907-543-6319
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Fax | 907-543-6319
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 25-1807-I
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License Number State | AK
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