MEDICARE: DR. HOR BORN CHHAY M.D.

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	208D00000X	General Practice Physician	A56425	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AC0032550	OTHER	CA	ACUPUNCTURE PRIVIDER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497842256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOR BORN CHHAY M.D.

Provider Business Mailing Address
First Line	:	1862 E ANAHEIM ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3906
Country	:	US
Telephone Number	:	562-218-4298
Fax Number	:	562-218-1480

Provider Business Practice Location Address
First Line	:	1862 E ANAHEIM ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3906
Country	:	US
Telephone Number	:	562-218-4298
Fax Number	:	562-218-1480

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/09/2007

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