Healthcare Provider Details

I. General information

NPI: 1285395269
Provider Name (Legal Business Name): DR. ERIC CHAGHOURI M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11150 W OLYMPIC BLVD STE 775
LOS ANGELES CA
90064-1850
US

IV. Provider business mailing address

11150 W OLYMPIC BLVD STE 775
LOS ANGELES CA
90064-1850
US

V. Phone/Fax

Practice location:
  • Phone: 424-307-9503
  • Fax:
Mailing address:
  • Phone: 424-307-9503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ERIC CHAGHOURI
Title or Position: CEO
Credential: MD
Phone: 310-850-8657