Provider Demographics
NPI:1124170683
Name:CHA, JOHN Y (D P M)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:Y
Last Name:CHA
Suffix:
Gender:M
Credentials:D P M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 E REGENT ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1415
Mailing Address - Country:US
Mailing Address - Phone:310-672-5893
Mailing Address - Fax:310-672-1825
Practice Address - Street 1:656 EAST REGENT ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1415
Practice Address - Country:US
Practice Address - Phone:310-672-5893
Practice Address - Fax:310-672-1825
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3929213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E39290Medicaid
CAWE3929EMedicare PIN
CA4668660001Medicare NSC
CA000E39290Medicaid