Provider Demographics
NPI:1063765105
Name:CONNIE CHEIN MD INC
Entity type:Organization
Organization Name:CONNIE CHEIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-274-8310
Mailing Address - Street 1:9242 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4659
Mailing Address - Country:US
Mailing Address - Phone:310-274-8310
Mailing Address - Fax:310-274-7025
Practice Address - Street 1:9242 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4659
Practice Address - Country:US
Practice Address - Phone:310-274-8310
Practice Address - Fax:310-274-7025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31986207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91384Medicare UPIN