=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467482190
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILIP NICHOLAS CHIRONIS I M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 361 HOSPITAL RD STE 522
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92663-3526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-645-5918
-----------------------------------------------------
Fax | 949-645-0453
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 361 HOSPITAL RD STE 522
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92663-3526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-645-5918
-----------------------------------------------------
Fax | 949-645-0453
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | A43707
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------