Provider Demographics
NPI:1538267901
Name:CHA, TIM KWANG (MD)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:KWANG
Last Name:CHA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3440 LOMITA BLVD
Mailing Address - Street 2:#138
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4801
Mailing Address - Country:US
Mailing Address - Phone:310-372-2821
Mailing Address - Fax:310-372-9358
Practice Address - Street 1:3440 LOMITA BLVD
Practice Address - Street 2:#138
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4801
Practice Address - Country:US
Practice Address - Phone:310-372-2821
Practice Address - Fax:310-372-9358
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-05-12
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Provider Licenses
StateLicense IDTaxonomies
CAA521972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF88846Medicare UPIN
CAA52197Medicare PIN