Basic Information
| Provider Information | |||||||||
| NPI: | 1780621755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAO | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | YUH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11411 BROOKSHIRE AVE STE 207 | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902415004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629044411 | ||||||||
| FaxNumber: | 5629045353 | ||||||||
| Practice Location | |||||||||
| Address1: | 11411 BROOKSHIRE AVE STE 207 | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902415004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629044411 | ||||||||
| FaxNumber: | 5629045353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 02/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R2A51 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 20A4859 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 241216829 | 05 | MO | MEDICAID |