Provider Demographics
NPI:1104972462
Name:CHEW, ERIC E (PA-C)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:E
Last Name:CHEW
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E HARDY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4054
Mailing Address - Country:US
Mailing Address - Phone:310-672-3900
Mailing Address - Fax:310-671-8438
Practice Address - Street 1:501 E HARDY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4054
Practice Address - Country:US
Practice Address - Phone:310-672-3900
Practice Address - Fax:310-671-8438
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 13921363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA142951OtherCA ACADEMY OF PA'S
CAGR0031380Medicaid
CAPA 13921OtherPA LICENSE
CAPA 13921OtherPA LICENSE
CAMC0500997OtherDEA
CAGR0031380Medicaid