MEDICARE: BEHNAM KACHOUEI D.O.

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	174400000X	Specialist	20A17361	CA
2	208000000X	Pediatrics Physician	20A17361	CA
3	207Q00000X	Family Medicine Physician	20A17361	CA

General Provider Information

NPI Number	:	1518345453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEHNAM KACHOUEI D.O.

Provider Business Mailing Address
First Line	:	2011 E TAM O SHANTER ST
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-6455
Country	:	US
Telephone Number	:	909-638-4045
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 E TACHEVAH DR STE 2E204
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-5737
Country	:	US
Telephone Number	:	760-561-7344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2015
Last Update Date	:	04/20/2023

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