Provider Demographics
NPI:1679657241
Name:CHIVAS, DANIEL J
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:CHIVAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-1001
Mailing Address - Country:US
Mailing Address - Phone:323-226-2170
Mailing Address - Fax:323-226-5760
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-1001
Practice Address - Country:US
Practice Address - Phone:323-226-2170
Practice Address - Fax:323-226-5760
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-12-08
Deactivation Date:2015-05-15
Deactivation Code:
Reactivation Date:2016-02-16
Provider Licenses
StateLicense IDTaxonomies
CAA96197207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW809FMedicare ID - Type UnspecifiedEL MONTE
CAW809BMedicare ID - Type UnspecifiedHUDSON
CAW809AMedicare ID - Type UnspecifiedROYBAL
CAW932Medicare ID - Type UnspecifiedHEALTH CENTER