MEDICARE: DR. ANDREW CHAO 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	207VM0101X	Maternal & Fetal Medicine Physician	G46081	CA
2	174400000X	Specialist	G46081	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1972578896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW CHAO M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 967
Second Line	:
City	:	LODI
State	:	CA
Zip	:	95241-0967
Country	:	US
Telephone Number	:	209-334-1800
Fax Number	:	209-334-2416

Provider Business Practice Location Address
First Line	:	1617 N CALIFORNIA ST
Second Line	:	STE. 2D
City	:	STOCKTON
State	:	CA
Zip	:	95204-6117
Country	:	US
Telephone Number	:	209-933-9888
Fax Number	:	209-933-9988

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	01/28/2015

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