Provider Demographics
NPI:1134345473
Name:NEWPORT DIAGNOSTIC RADIOLOGY, INC
Entity type:Organization
Organization Name:NEWPORT DIAGNOSTIC RADIOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAZEM
Authorized Official - Middle Name:H
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13996Medicare ID - Type Unspecified