Provider Demographics
NPI:1467518209
Name:CHIRASEVEENUPRAPUND, PETER (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:CHIRASEVEENUPRAPUND
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:CHIRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MS
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:MC5003
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-309-6300
Mailing Address - Fax:
Practice Address - Street 1:7920 FROST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2736
Practice Address - Country:US
Practice Address - Phone:858-966-8082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010696242080P0216X
CAA682772080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201026580Medicaid
INM400065090Medicare PIN