Healthcare Provider Details

I. General information

NPI: 1609183730
Provider Name (Legal Business Name): CHADI CHAHIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TER
GLENDALE CA
91206-4007
US

IV. Provider business mailing address

PO BOX 11330
GLENDALE CA
91226-7330
US

V. Phone/Fax

Practice location:
  • Phone: 661-287-3162
  • Fax: 661-287-3951
Mailing address:
  • Phone: 661-287-3162
  • Fax: 661-287-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA101516
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA101516
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA101516
License Number StateCA

VIII. Authorized Official

Name: CHADI CHAHIN
Title or Position: PRESIDENT
Credential: MD
Phone: 661-287-3162