Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G81865 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | G81865 | CA |
NPI | 1043374473 |
---|---|
Provider Name | Dr. Chyle E Beaird |
First Address | Placentia, CA 92870-1717 |
Second Address | Lake Forest, CA 92630-3949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 15/03/2018 |