Mudjianto Chandra, M.D., Inc.
LBN: Mudjianto Chandra, M.D., Inc.
Mudjianto Chandra, M.D., Inc. is an health care organization with primary practice located at 18370 Burbank Blvd Suite 607, Tarzana CA 91356-2804. The organization 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 the primary health care specialty.
Mudjianto Chandra, M.D., Inc. can be contacted via phone (818) 708-1004, or through Chandra, Mudjianto via phone (818) 708-1004.
Contact Information
Primary practice address
18370 Burbank Blvd Suite 607
Tarzana CA 91356-2804
Phone: (818) 708-1004
Fax: (818) 342-2141
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 | 1083658827 |
|---|---|
| LBN Legal business name | Mudjianto Chandra, M.D., Inc. |
| DBA Doing business as | |
| Authorized official | Chandra, Mudjianto Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jun 15th, 2006 |
| Last updated | Aug 22nd, 2020 - about 4 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083658827 | NPPES |
| Other | 00A521980 | BLUE SHIELD | |
| Other | P92709600 | BLUE SHIELD | |
| MEDICAID | 00A521980 | BLUE SHIELD | |
| Other | A52198 | BLUE SHIELD |
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