Basic Information
| Provider Information | |||||||||
| NPI: | 1417003930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANDER | ||||||||
| FirstName: | SUBASH | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5475 WALNUT AVE | ||||||||
| Address2: | |||||||||
| City: | CHINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917102609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095916446 | ||||||||
| FaxNumber: | 9095911309 | ||||||||
| Practice Location | |||||||||
| Address1: | 5475 WALNUT AVE | ||||||||
| Address2: | |||||||||
| City: | CHINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917102609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095916446 | ||||||||
| FaxNumber: | 9095911309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 12/27/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A88255 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | BC7406362 | 01 | CA | DEA | OTHER | A88255 | 01 | CA | MEDICAL LISENCE | OTHER |