Healthcare Provider Details

I. General information

NPI: 1679657241
Provider Name (Legal Business Name): DR. DANIEL J CHIVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date: 05/15/2015
Reactivation Date: 02/16/2016

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90089-1001
US

IV. Provider business mailing address

1200 N STATE ST
LOS ANGELES CA
90089-1001
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-2170
  • Fax: 323-226-5760
Mailing address:
  • Phone: 323-226-2170
  • Fax: 323-226-5760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA96197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: