Healthcare Provider Details

I. General information

NPI: 1235450305
Provider Name (Legal Business Name): NISHAN TCHEKMEDYIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NISHAN TCHEKMEDYIAN M.D.

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 MAIN ST STE 300
HUNTINGTON BEACH CA
92648-2489
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 714-252-9415
  • Fax: 714-963-8407
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA137047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: