Healthcare Provider Details

I. General information

NPI: 1528172996
Provider Name (Legal Business Name): HAZEM H CHEHABI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 AVOCADO
NEWPORT BEACH CA
92660
US

IV. Provider business mailing address

PO BOX 8073
NEWPORT BEACH CA
92658-8073
US

V. Phone/Fax

Practice location:
  • Phone: 949-760-3025
  • Fax: 949-720-3944
Mailing address:
  • Phone: 949-760-3025
  • Fax: 949-720-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberA44061
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA44061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: