Provider Demographics
NPI:1902888043
Name:CHOOLJIAN, DIANNA (MD PHD MPH)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:CHOOLJIAN
Suffix:
Gender:F
Credentials:MD PHD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 PASEO DEL MAR
Mailing Address - Street 2:
Mailing Address - City:PVE
Mailing Address - State:CA
Mailing Address - Zip Code:90274
Mailing Address - Country:US
Mailing Address - Phone:310-373-5192
Mailing Address - Fax:310-373-5192
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-933-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG575792085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G575790OtherMEDICAL
F36820Medicare UPIN
CAWG57579HMedicare UPIN
BK770ZMedicare PIN