Provider Demographics
NPI:1861591307
Name:CHAITIN, BARRY FREDRICK (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:FREDRICK
Last Name:CHAITIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54739
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90054-0739
Mailing Address - Country:US
Mailing Address - Phone:714-456-5951
Mailing Address - Fax:714-456-6190
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:BLDG 3
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-5951
Practice Address - Fax:714-456-6190
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG211652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG21665AMedicare ID - Type UnspecifiedHW3525
CAWG21165BMedicare ID - Type UnspecifiedW3525
CAA90686Medicare UPIN