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General NPI Number Information
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NPI Number | 1134384407
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Entity Type | Organization
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Legal Business Name | MARJAN CHEGOUNCHI MD INC
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Dates
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Enumeration Date | 07/25/2008
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 501 E HARDY ST STE 205
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City | INGLEWOOD
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State | CA
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Zip | 90301-4054
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Country | US
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Telephone | 310-671-6364
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Fax | 310-671-8184
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Provider Business Mailing Address
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Address Line | PO BOX 390005
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City | SAN DIEGO
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State | CA
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Zip | 92149-0005
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Country | US
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Telephone | 619-746-6530
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Fax | 619-746-6528
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARJAN CHEGOUNCHI
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Credential | MD
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Telephone | 619-746-6530
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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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