Provider Demographics
NPI:1689868259
Name:KEVIN J. CHAMAS INC.
Entity Type:Organization
Organization Name:KEVIN J. CHAMAS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:CHAMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-564-2005
Mailing Address - Street 1:802 DICKSON ST
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5511
Mailing Address - Country:US
Mailing Address - Phone:310-564-2005
Mailing Address - Fax:
Practice Address - Street 1:3333 MANNING AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4804
Practice Address - Country:US
Practice Address - Phone:310-564-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG058541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty