Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A36253 | CA |
N | 208D00000X | General Practice Physician | A36253 | CA |
NPI | 1043306624 |
---|---|
Provider Name | Dr. Kasin Ekmaha Chai |
First Address | Santa Ana, CA 92704-3476 |
Second Address | Santa Ana, CA 92704-3476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 15/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A362530 | (05) | CA |
A28018 | (02) | CA |