Provider Demographics
NPI:1285660456
Name:CHEGOUNCHI, MARJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJAN
Middle Name:
Last Name:CHEGOUNCHI
Suffix:
Gender:F
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:PO BOX 390005
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92149-0005
Mailing Address - Country:US
Mailing Address - Phone:619-746-6530
Mailing Address - Fax:619-746-6528
Practice Address - Street 1:501 E HARDY ST
Practice Address - Street 2:STE 205
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4054
Practice Address - Country:US
Practice Address - Phone:310-671-6364
Practice Address - Fax:310-671-8184
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80479207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI32817Medicare UPIN