Provider Demographics
NPI:1356617922
Name:NEWPORT BEACH RADIOSURGERY CENTER, LLC
Entity type:Organization
Organization Name:NEWPORT BEACH RADIOSURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAZEM
Authorized Official - Middle Name:HIKMAT
Authorized Official - Last Name:CHEHABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-760-3025
Mailing Address - Street 1:1605 AVOCADO AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7725
Mailing Address - Country:US
Mailing Address - Phone:949-760-3025
Mailing Address - Fax:949-720-3944
Practice Address - Street 1:1605 AVOCADO AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7725
Practice Address - Country:US
Practice Address - Phone:949-760-3025
Practice Address - Fax:949-720-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty