MEDICARE: DR MINA CHA DDS PA

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	122300000X	Dentist	16816	TX

General Provider Information

NPI Number	:	1447353933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR MINA CHA DDS PA

Provider Business Mailing Address
First Line	:	1825 BANDERA ROAD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228
Country	:	US
Telephone Number	:	210-434-8431
Fax Number	:	210-432-8130

Provider Business Practice Location Address
First Line	:	1825 BANDERA ROAD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228
Country	:	US
Telephone Number	:	210-434-8431
Fax Number	:	210-432-8130

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MINA CHA
Credential	:	DDS
Telephone Number	:	210-434-8431

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	08/22/2020

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