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:
Map and Directions
Authorized official contact:
Name: Chandra, Mudjianto Doctor of Medicine (MD)
Phone: (818) 708-1004

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 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 5 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.

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Identifiers

StateTypeNumberIssuer
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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