Provider Demographics
NPI:1184670408
Name:CHALIAN, RAFFI A (MD)
Entity Type:Individual
Prefix:
First Name:RAFFI
Middle Name:A
Last Name:CHALIAN
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 1:351 HOSPITAL RD STE 507
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3500
Mailing Address - Country:US
Mailing Address - Phone:949-642-1361
Mailing Address - Fax:949-642-3202
Practice Address - Street 1:1505 WILSON TER STE 150
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206
Practice Address - Country:US
Practice Address - Phone:818-484-8611
Practice Address - Fax:818-484-8711
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122745207VX0201X
PAMD428752207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101834663Medicaid
NJ0123129Medicaid
PA101834663Medicaid