Provider Demographics
NPI:1427336593
Name:CHHITH, SERIRITHANAR (MD)
Entity type:Individual
Prefix:DR
First Name:SERIRITHANAR
Middle Name:
Last Name:CHHITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 CLAIR DEL AVE APT 813
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-5544
Mailing Address - Country:US
Mailing Address - Phone:310-709-9171
Mailing Address - Fax:
Practice Address - Street 1:455 E COLUMBIA ST STE 201&6
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1620
Practice Address - Country:US
Practice Address - Phone:562-933-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-23
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124273208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC-11466FOtherMEDI-CAL
CA05-1110OtherMEDICARE