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General NPI Number Information
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NPI Number | 1780858605
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Entity Type | Organization
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Legal Business Name | SOON M. CHA MD, INC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 1058 S VERMONT AVE STE 204
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City | LOS ANGELES
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State | CA
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Zip | 90006-2731
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Country | US
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Telephone | 213-368-6020
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Fax |
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Provider Business Mailing Address
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Address Line | 1058 S VERMONT AVE STE 204
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City | LOS ANGELES
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State | CA
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Zip | 90006-2731
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Country | US
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Telephone | 213-368-6020
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SOON M. CHA
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Credential | MD
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Telephone | 213-368-6020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | A39746
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License Number State | CA
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