Healthcare Provider Details

I. General information

NPI: 1427336593
Provider Name (Legal Business Name): SERIRITHANAR CHHITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2011
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E COLUMBIA ST STE 201&6
LONG BEACH CA
90806-1620
US

IV. Provider business mailing address

4701 CLAIR DEL AVE APT 813
LONG BEACH CA
90807-5544
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-0400
  • Fax:
Mailing address:
  • Phone: 310-709-9171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA124273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: