Provider Demographics
NPI:1740241298
Name:CHANNING, ARNOLD (MD)
Entity Type:Individual
Prefix:
First Name:ARNOLD
Middle Name:
Last Name:CHANNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 LINDLEY AVE
Mailing Address - Street 2:#19
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1957
Mailing Address - Country:US
Mailing Address - Phone:818-776-1311
Mailing Address - Fax:818-773-7501
Practice Address - Street 1:5420 LINDLEY AVE
Practice Address - Street 2:#19
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1957
Practice Address - Country:US
Practice Address - Phone:818-776-1311
Practice Address - Fax:818-773-7501
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG5734207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G57340Medicaid
CA00G57340Medicaid
CAWG5734JMedicare ID - Type UnspecifiedPPIN