Provider Demographics
NPI:1114035771
Name:BRIAN M. CHESNIE, M.D., INC.
Entity Type:Organization
Organization Name:BRIAN M. CHESNIE, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CHESNIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-574-4953
Mailing Address - Street 1:PO BOX 1728
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0728
Mailing Address - Country:US
Mailing Address - Phone:949-574-4953
Mailing Address - Fax:949-229-6297
Practice Address - Street 1:1501 SUPERIOR AVE STE 212
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3640
Practice Address - Country:US
Practice Address - Phone:949-574-4953
Practice Address - Fax:949-229-6297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41393174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWC41393DOtherPTAN
CAWC41393DOtherPTAN
CAA37583Medicare UPIN