MEDICARE: KEVIN J. CHAMAS INC.

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	207Q00000X	Family Medicine Physician	G058541	CA

General Provider Information

NPI Number	:	1689868259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN J. CHAMAS INC.

Provider Business Mailing Address
First Line	:	802 DICKSON ST
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-5511
Country	:	US
Telephone Number	:	310-564-2005
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 MANNING AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-4804
Country	:	US
Telephone Number	:	310-564-2005
Fax Number	:

Authorized Official
Title or Position	:	CEO AND PRESIDENT
Name	:	DR. KEVIN JUSTIN CHAMAS
Credential	:	M.D.
Telephone Number	:	310-564-2005

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	07/30/2013

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