MEDICARE: JINWHAN CHA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085N0700X	Neuroradiology Physician	34.016371	OH
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2085N0700X	Neuroradiology Physician	100674	GA

General Provider Information

NPI Number	:	1215475132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JINWHAN CHA D.O.

Provider Business Mailing Address
First Line	:	4442 LAKE ST
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-3920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-4701
Country	:	US
Telephone Number	:	216-444-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2017
Last Update Date	:	07/15/2024

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