Provider Demographics
NPI:1467482190
Name:CHIRONIS, PHILIP NICHOLAS I (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:NICHOLAS
Last Name:CHIRONIS
Suffix:I
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 1:361 HOSPITAL RD STE 522
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3526
Mailing Address - Country:US
Mailing Address - Phone:949-645-5918
Mailing Address - Fax:949-645-0453
Practice Address - Street 1:361 HOSPITAL RD STE 522
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3526
Practice Address - Country:US
Practice Address - Phone:949-645-5918
Practice Address - Fax:949-645-0453
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43707207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE93846Medicare UPIN
CAW14450Medicare ID - Type UnspecifiedGROUP