Basic Information
| Provider Information | |||||||||
| NPI: | 1053488114 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEEMA | ||||||||
| FirstName: | CHANDAN | ||||||||
| MiddleName: | D S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6608 MERCY CT STE B | ||||||||
| Address2: | |||||||||
| City: | FAIR OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956283171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162419844 | ||||||||
| FaxNumber: | 9162419845 | ||||||||
| Practice Location | |||||||||
| Address1: | 6608 MERCY CT STE B | ||||||||
| Address2: | |||||||||
| City: | FAIR OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956283171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162419844 | ||||||||
| FaxNumber: | 9162419845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 05/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | A47747 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207R00000X | A477470 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0A477470 | 01 | CA | MEDICAL | OTHER |