Provider Demographics
NPI:1588769194
Name:CHOAN, CEDRIC (MD)
Entity type:Individual
Prefix:
First Name:CEDRIC
Middle Name:
Last Name:CHOAN
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 1:14120 ALONDRA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-5842
Mailing Address - Country:US
Mailing Address - Phone:562-407-2080
Mailing Address - Fax:562-407-2082
Practice Address - Street 1:180 NEWPORT CENTER DR STE 157
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0934
Practice Address - Country:US
Practice Address - Phone:949-719-1800
Practice Address - Fax:714-647-1245
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50684207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA50684EMedicare PIN
CACM860XMedicare PIN
CACM860W (RESTFUL SB)Medicare PIN
CACM860V (RESTFUL LA)Medicare PIN