Provider Demographics
NPI:1598708778
Name:CHAKERIAN, MAIA U (MD)
Entity Type:Individual
Prefix:
First Name:MAIA
Middle Name:U
Last Name:CHAKERIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 DARDANELLI LN
Mailing Address - Street 2:STE 2G
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1421
Mailing Address - Country:US
Mailing Address - Phone:408-356-0503
Mailing Address - Fax:408-356-4704
Practice Address - Street 1:360 DARDANELLI LN
Practice Address - Street 2:STE 2G
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1421
Practice Address - Country:US
Practice Address - Phone:408-356-0503
Practice Address - Fax:408-356-4704
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG60149207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050073929Medicare PIN
E10766Medicare UPIN
CA00G601490Medicare PIN