Healthcare Provider Details

I. General information

NPI: 1124356043
Provider Name (Legal Business Name): CHJ DIAGNOSTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E CHAPMAN AVE SUITE E
ORANGE CA
92866-1641
US

IV. Provider business mailing address

550 E CHAPMAN AVE SUITE E
ORANGE CA
92866-1641
US

V. Phone/Fax

Practice location:
  • Phone: 714-602-7374
  • Fax: 714-602-7388
Mailing address:
  • Phone: 714-602-7374
  • Fax: 714-602-7388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ALFRED LEVONIANS
Title or Position: PESIDENT
Credential:
Phone: 818-568-0006