Healthcare Provider Details

I. General information

NPI: 1679701817
Provider Name (Legal Business Name): TRACY CHIEM HATZOPOULOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY CHIEM M.D.

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ANAHEIM KRAEMER MEDICAL OFFICE 1 3460 EAST LA PALMA AVENUE
ANAHEIM CA
92806
US

IV. Provider business mailing address

ANAHEIM KRAEMER MEDICAL OFFICE 1 3460 EAST LA PALMA AVENUE
ANAHEIM CA
92806
US

V. Phone/Fax

Practice location:
  • Phone: 888-988-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA125072
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberA125072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: