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:
Health care specialties
Specialty | Code | License # | 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 18 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
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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