=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457634628
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRIS RAJ CHAUHAN M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2011
-----------------------------------------------------
Last Update Date | 01/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 480 PASEO CAMARILLO APT 203
-----------------------------------------------------
City | CAMARILLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-402-8820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 480 PASEO CAMARILLO APT 203
-----------------------------------------------------
City | CAMARILLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93010-5986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-402-8820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | A125412
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------