Healthcare Provider Details

I. General information

NPI: 1982976106
Provider Name (Legal Business Name): XENON MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6464 SUNSET BLVD SUITE 790
HOLLYWOOD CA
90028-8006
US

IV. Provider business mailing address

6464 SUNSET BLVD SUITE 790
HOLLYWOOD CA
90028-8006
US

V. Phone/Fax

Practice location:
  • Phone: 516-640-5863
  • Fax: 646-304-1681
Mailing address:
  • Phone: 516-640-5863
  • Fax: 646-304-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number211953
License Number StateNY

VIII. Authorized Official

Name: DR. HAROON W CHAUDHRY
Title or Position: PRESIDENT
Credential: MD
Phone: 516-640-5863