Healthcare Provider Details

I. General information

NPI: 1326319021
Provider Name (Legal Business Name): AMINE RABAH CHAHBOUNI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 HAYES
IRVINE CA
92620-3753
US

IV. Provider business mailing address

608 HAYES
IRVINE CA
92620-3753
US

V. Phone/Fax

Practice location:
  • Phone: 949-322-5521
  • Fax:
Mailing address:
  • Phone: 949-322-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A 11525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: