Provider Demographics
NPI:1902975220
Name:CHAO, LISSETTE (PA)
Entity Type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:CHAO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1800 HARRISON ST FL 7
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3466
Mailing Address - Country:US
Mailing Address - Phone:510-625-2856
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:300A FAUNCE CORNER RD
Practice Address - Street 2:
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1280
Practice Address - Country:US
Practice Address - Phone:508-973-1100
Practice Address - Fax:508-973-1105
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA1976363A00000X
MA1976363A00000X
CA53879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant