Provider Demographics
NPI:1841653714
Name:FIDAI, CHELSEA GRIMES (MD)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:GRIMES
Last Name:FIDAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:MIDORI
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1500 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5211
Mailing Address - Country:US
Mailing Address - Phone:310-927-6075
Mailing Address - Fax:
Practice Address - Street 1:1101 N SEPULVEDA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5962
Practice Address - Country:US
Practice Address - Phone:310-546-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA171819207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology