Basic Information
| Provider Information | |||||||||
| NPI: | 1023365939 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | METCHNIKOFF | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 W. CARSON STREET, BOX 400 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905092910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102222401 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14445 OLIVE VIEW DR # 2B-182 | ||||||||
| Address2: | |||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913421437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7472103205 | ||||||||
| FaxNumber: | 7472104573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2012 | ||||||||
| LastUpdateDate: | 12/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/19/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A129294 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0401X | A129294 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 207RH0002X | A129294 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
No ID Information.