Healthcare Provider Details

I. General information

NPI: 1063947539
Provider Name (Legal Business Name): CHEST AND CRITICAL CARE CONSULTANTS, A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 E YORBA LINDA BLVD SUITE 306
PLACENTIA CA
92870-3728
US

IV. Provider business mailing address

PO BOX 15090
ANAHEIM CA
92803-5090
US

V. Phone/Fax

Practice location:
  • Phone: 714-577-9500
  • Fax: 714-577-9504
Mailing address:
  • Phone: 714-232-2301
  • Fax: 714-202-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HARMOHINDER GOGIA
Title or Position: SENIOR MANAGING PARTNER
Credential: M.D.
Phone: 714-577-2124