Healthcare Provider Details

I. General information

NPI: 1649635095
Provider Name (Legal Business Name): WILLIAM CHERNIAK MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20311 SW ACACIA ST STE 140
NEWPORT BEACH CA
92660-1733
US

IV. Provider business mailing address

2219 MAIN ST UNIT 653
SANTA MONICA CA
90405-2217
US

V. Phone/Fax

Practice location:
  • Phone: 831-777-4283
  • Fax:
Mailing address:
  • Phone: 831-777-4283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberD80655
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA157750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: