Chandra, Mudjianto

Chandra, Mudjianto is an individual health care provider with primary practice located at 18370 Burbank Blvd Suite 607, Tarzana CA 91356-2804. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Colon & Rectal Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Chandra, Mudjianto can be contacted via phone (818) 709-8161.

Contact Information

Primary practice address
18370 Burbank Blvd Suite 607 Tarzana CA 91356-2804
Phone: (818) 709-8161
Fax: (818) 709-8160
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X A52198 California
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X A52198 California

Profile Details

NPI number 1225152515
LBN Legal business name Chandra, Mudjianto
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 19th, 2007
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225152515 NPPES
California Other 00A521980 BLUE SHIELD
California Other A52198 BLUE SHIELD
California Other A52198 BLUE SHIELD
California Other P92709600 BLUE SHIELD
California Other A52198 BLUE SHIELD
California MEDICAID 00A521980 BLUE SHIELD

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