MEDICARE: DR. CHARLES W CHIA 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	207N00000X	Dermatology Physician	A108491	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00348654	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841229069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES W CHIA M.D.

Provider Business Mailing Address
First Line	:	145 HODENCAMP RD
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-5810
Country	:	US
Telephone Number	:	818-719-4643
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 HODENCAMP RD
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-5810
Country	:	US
Telephone Number	:	818-719-4643
Fax Number	:

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	11/30/2021

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