Provider Demographics
NPI:1073971412
Name:CYNTHIA W. CHAO, D.O., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:CYNTHIA W. CHAO, D.O., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-961-3137
Mailing Address - Street 1:PO BOX 14467
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90853-4467
Mailing Address - Country:US
Mailing Address - Phone:562-208-6642
Mailing Address - Fax:
Practice Address - Street 1:10861 CHERRY ST STE 109
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5400
Practice Address - Country:US
Practice Address - Phone:562-961-3137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-31
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7343261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720077274Medicare UPIN