Jaesoon Katie Cha, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

VN221010 Issued in CA

Practice address

716 Fuller St
Fort Huachuca, AZ 85613-1624

Phone

(520) 533-9113

Fax

(520) 533-5148

NPI assigned

Jul 18, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468800000000",
    "number": "1275986986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 FULLER ST",
            "city": "FORT HUACHUCA",
            "state": "AZ",
            "postal_code": "856131624",
            "telephone_number": "520-533-9113",
            "fax_number": "520-533-5148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 FULLER ST",
            "city": "FORT HUACHUCA",
            "state": "AZ",
            "postal_code": "856131624",
            "telephone_number": "520-533-9113",
            "fax_number": "520-533-5148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHA",
        "first_name": "JAESOON",
        "middle_name": "KATIE",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-18",
        "last_updated": "2016-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "CA",
            "license": "VN221010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Louis Francis Campana II, DMD
• Paul Anthony Cannava, D.M.D.
• Henry Hugh Canton, M.D.
• Mercy W Carbone, LPN
• Samuel Robert Caron, PH.D.
• Kay Chaparro
• Rachelle Chapman, NURSE
• Mary Ann Clark
• John P Cofer, DDS
• William Collazo-Nunez, M.D.

• Licensed Practical Nurse in Fort Huachuca, AZ
• Providers in Fort Huachuca, AZ by specialty
• Licensed Practical Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.