Provider Demographics
NPI:1316974652
Name:CHAKMAKIAN, VACHE (MD)
Entity type:Individual
Prefix:DR
First Name:VACHE
Middle Name:
Last Name:CHAKMAKIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73726 KANDINSKY WAY
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-4557
Mailing Address - Country:US
Mailing Address - Phone:805-714-0122
Mailing Address - Fax:
Practice Address - Street 1:437 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3456
Practice Address - Country:US
Practice Address - Phone:909-988-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G619480Medicaid
CAE49248Medicare UPIN
CACO525ZMedicare PIN
CAWG61948JMedicare PIN
CAWG61948IMedicare PIN