Provider Demographics
NPI:1528062023
Name:CHAIKEN, LISA MARTINE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARTINE
Last Name:CHAIKEN
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:PO BOX 513969
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-3969
Mailing Address - Country:US
Mailing Address - Phone:310-335-4065
Mailing Address - Fax:310-335-4098
Practice Address - Street 1:2121 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2303
Practice Address - Country:US
Practice Address - Phone:310-829-8913
Practice Address - Fax:310-315-6168
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG668802085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G668800Medicaid
920002903OtherRAILROAD MEDICARE
CAP00461553OtherRAILROAD MEDICARE
CA1528062023Medicaid
CA1528062023Medicaid
CACH618ZMedicare PIN
F58515Medicare UPIN