Provider Demographics
NPI:1194736710
Name:CHERLOW, JOEL M (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:M
Last Name:CHERLOW
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 ELM AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1651
Mailing Address - Country:US
Mailing Address - Phone:562-492-6695
Mailing Address - Fax:562-988-0389
Practice Address - Street 1:24953 PASEO DE VALENCIA
Practice Address - Street 2:SUITE B1
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4342
Practice Address - Country:US
Practice Address - Phone:949-452-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG424602085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG42460OtherLICENSE
CA00G042460Medicaid
AC9328685OtherDEA
CA00G042460Medicaid
WG42460DMedicare ID - Type Unspecified
A48975Medicare UPIN
WG42460AMedicare ID - Type Unspecified