MEDICARE: DR. ERIC CHAGHOURI M.D., A PROFESSIONAL MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1285395269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ERIC CHAGHOURI M.D., A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	11150 W OLYMPIC BLVD STE 775
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1850
Country	:	US
Telephone Number	:	424-307-9503
Fax Number	:

Provider Business Practice Location Address
First Line	:	11150 W OLYMPIC BLVD STE 775
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1850
Country	:	US
Telephone Number	:	424-307-9503
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. ERIC CHAGHOURI
Credential	:	MD
Telephone Number	:	310-850-8657

Provider Enumeration Date	:	01/03/2022
Last Update Date	:	10/03/2025

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