Healthcare Provider Details

I. General information

NPI: 1750576229
Provider Name (Legal Business Name): CEDRIC CHOAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 NEWPORT CENTER DR STE 157
NEWPORT BEACH CA
92660-0934
US

IV. Provider business mailing address

14120 ALONDRA BLVD STE C
SANTA FE SPRINGS CA
90670-5842
US

V. Phone/Fax

Practice location:
  • Phone: 949-719-1800
  • Fax: 714-647-1245
Mailing address:
  • Phone: 562-407-2080
  • Fax: 562-407-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA050684
License Number StateCA

VIII. Authorized Official

Name: CEDRIC CHOAN
Title or Position: PRESIDENT
Credential: MD
Phone: 562-407-2080