Provider Demographics
NPI:1548361348
Name:CHA, DAVID SUNG GEUN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SUNG GEUN
Last Name:CHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91- 2139 FORT WEAVER RD
Mailing Address - Street 2:211
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:808-671-7216
Mailing Address - Fax:808-676-5458
Practice Address - Street 1:91-2139 FORT WEAVER RD
Practice Address - Street 2:211
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706
Practice Address - Country:US
Practice Address - Phone:808-671-7216
Practice Address - Fax:808-676-5458
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD8292208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI053822Medicaid
H02971Medicare UPIN
HI053822Medicaid