Provider Demographics
NPI:1962433607
Name:CHWA, ERIC MELVIN (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:MELVIN
Last Name:CHWA
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 1:632 W DUARTE RD STE 180
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7609
Mailing Address - Country:US
Mailing Address - Phone:626-821-6411
Mailing Address - Fax:626-821-6414
Practice Address - Street 1:632 W DUARTE RD STE 180
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7609
Practice Address - Country:US
Practice Address - Phone:626-821-6411
Practice Address - Fax:626-821-6414
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A495061Medicaid
CAA49506Medicare ID - Type Unspecified
CA00A495061Medicaid