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General NPI Number Information
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NPI Number | 1114428372
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Entity Type | Organization
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Legal Business Name | M CHEGOUNCHI MD INC
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 11860 WILSHIRE BLVD STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90025-6606
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Country | US
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Telephone | 310-473-3030
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Fax | 310-473-4848
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Provider Business Mailing Address
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Address Line | 11860 WILSHIRE BLVD STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90025-6606
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Country | US
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Telephone | 310-473-3030
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Fax | 310-473-4848
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARJAN CHEGOUNCHI
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Credential | MD
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Telephone | 310-473-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A80479
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License Number State | CA
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