Provider Demographics
NPI:1023357431
Name:CHERNOF, BRUCE ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLEN
Last Name:CHERNOF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3800 KILROY AIRPORT WAY
Mailing Address - Street 2:THE SCAN FOUNDATION, SUITE 400
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2494
Mailing Address - Country:US
Mailing Address - Phone:562-308-2858
Mailing Address - Fax:562-308-2707
Practice Address - Street 1:3800 KILROY AIRPORT WAY
Practice Address - Street 2:THE SCAN FOUNDATION, SUITE 400
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2494
Practice Address - Country:US
Practice Address - Phone:562-308-2858
Practice Address - Fax:562-308-2707
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG66646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66646OtherPHYSICIANS AND SURGEONS LICENSE
CAG66646OtherPHYSICIANS AND SURGEONS LICENSE