Provider Demographics
NPI:1700031705
Name:CATHERINE CHERN MD INC
Entity Type:Organization
Organization Name:CATHERINE CHERN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-848-8891
Mailing Address - Street 1:PO BOX 92046
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-2046
Mailing Address - Country:US
Mailing Address - Phone:818-848-8891
Mailing Address - Fax:
Practice Address - Street 1:201 S BUENA VISTA ST
Practice Address - Street 2:STE 300
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4569
Practice Address - Country:US
Practice Address - Phone:818-848-8891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA66679OtherLICENSE