Provider Demographics
NPI:1487754396
Name:CHYNEL HENNING, M.D.
Entity type:Organization
Organization Name:CHYNEL HENNING, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHYNEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:HENNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-377-0389
Mailing Address - Street 1:PO BOX 7630
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-7630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3816 WOODRUFF AVE
Practice Address - Street 2:STE. 104
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2147
Practice Address - Country:US
Practice Address - Phone:562-377-0389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0642679291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A266100OtherBLUE SHIELD
CALAB58488FMedicaid
00A266100OtherBLUE CROSS
=========OtherCHAMPUS ID
CAX558488Medicare PIN