Healthcare Provider Details

I. General information

NPI: 1023765203
Provider Name (Legal Business Name): NIKKI CHINEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD STE 740
BEVERLY HILLS CA
90211-3121
US

IV. Provider business mailing address

PO BOX 3264
MANHATTAN BEACH CA
90266-1264
US

V. Phone/Fax

Practice location:
  • Phone: 818-465-8582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122852
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: