Provider Demographics
NPI:1356057590
Name:CHA, SON
Entity type:Individual
Prefix:
First Name:SON
Middle Name:
Last Name:CHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20921 NC 24 27 HWY
Mailing Address - Street 2:
Mailing Address - City:OAKBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28129-9508
Mailing Address - Country:US
Mailing Address - Phone:704-796-4377
Mailing Address - Fax:
Practice Address - Street 1:20921 NC 24 27 HWY
Practice Address - Street 2:
Practice Address - City:OAKBORO
Practice Address - State:NC
Practice Address - Zip Code:28129-9508
Practice Address - Country:US
Practice Address - Phone:704-796-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40428889Medicaid