MEDICARE: CHUCK DAHAN MD PA

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1801161955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHUCK DAHAN MD PA

Provider Business Mailing Address
First Line	:	2980 N BEVERLY GLEN CIR
Second Line	:	SUITE 301
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-1726
Country	:	US
Telephone Number	:	310-474-9809
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 E ALTAMONTE DR
Second Line	:	SUITE 201
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4823
Country	:	US
Telephone Number	:	407-339-7477
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHAKER M. DAHAN
Credential	:	MD
Telephone Number	:	407-339-7477

Provider Enumeration Date	:	03/21/2012
Last Update Date	:	03/21/2012

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