Provider Demographics
NPI:1568481679
Name:LUIS A CHANES M D INC
Entity type:Organization
Organization Name:LUIS A CHANES M D INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:CHANES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-557-5777
Mailing Address - Street 1:2621 S BRISTOL ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5766
Mailing Address - Country:US
Mailing Address - Phone:714-557-5777
Mailing Address - Fax:714-557-7710
Practice Address - Street 1:2621 S BRISTOL ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5766
Practice Address - Country:US
Practice Address - Phone:714-557-5777
Practice Address - Fax:714-557-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73198174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF30637Medicare UPIN
CAW15021Medicare ID - Type Unspecified