Provider Demographics
NPI:1164865291
Name:CHESTNUT PEDIATRICS
Entity Type:Organization
Organization Name:CHESTNUT PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-978-8669
Mailing Address - Street 1:766 E WOODHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1218
Mailing Address - Country:US
Mailing Address - Phone:559-978-8669
Mailing Address - Fax:559-322-2936
Practice Address - Street 1:7055 N CHESTNUT AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0350
Practice Address - Country:US
Practice Address - Phone:559-797-4400
Practice Address - Fax:559-797-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93159261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care