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General NPI Number Information
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NPI Number | 1922341783
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Entity Type | Organization
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Legal Business Name | JISUN CHA MD
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Dates
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Enumeration Date | 03/30/2013
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 460 SYLVAN AVE
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City | ENGLEWOOD
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State | NJ
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Zip | 07632-2919
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Country | US
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Telephone | 201-567-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 460 SYLVAN AVE
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City | ENGLEWOOD
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State | NJ
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Zip | 07632-2919
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Country | US
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Telephone | 201-567-0330
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JISUN CHA
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Credential | MD
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Telephone | 201-567-0330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25MA09071200
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License Number State | NJ
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