Provider Demographics
NPI:1306103684
Name:CHA, CAROL JANE HAN (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JANE HAN
Last Name:CHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 NE 100TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-3501
Mailing Address - Country:US
Mailing Address - Phone:207-712-4606
Mailing Address - Fax:
Practice Address - Street 1:14508 NE 20TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6434
Practice Address - Country:US
Practice Address - Phone:360-852-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8850207Q00000X
TX45215207Q00000X
390200000X
WA60547902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program