Basic Information
| Provider Information | |||||||||
| NPI: | 1679787550 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHEST AND CRITICAL CARE CONSULTANTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 W LA PALMA AVE | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928012815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147728282 | ||||||||
| FaxNumber: | 7147726493 | ||||||||
| Practice Location | |||||||||
| Address1: | 14350 WHITTIER BLVD | ||||||||
| Address2: | SUITE 315 | ||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906052138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624642163 | ||||||||
| FaxNumber: | 5629457737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 10/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | GOGIA | ||||||||
| AuthorizedOfficialFirstName: | HARMOHINDER | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7147728282 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHEST AND CRITICAL CARE CONSULTANTS | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | CR0969 | 01 | CA | MEDICARE RR | OTHER | GR0025655 | 05 | CA | MEDICAID |