Provider Demographics
NPI:1790479699
Name:TONI D JOHNSON CHAVIS MD INC
Entity Type:Organization
Organization Name:TONI D JOHNSON CHAVIS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON CHAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-774-6551
Mailing Address - Street 1:403 S LONG BEACH BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3491
Mailing Address - Country:US
Mailing Address - Phone:323-774-6551
Mailing Address - Fax:310-763-2315
Practice Address - Street 1:403 S LONG BEACH BLVD STE B
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3491
Practice Address - Country:US
Practice Address - Phone:323-774-6551
Practice Address - Fax:310-763-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center