Basic Information
Provider Information | |||||||||
NPI: | 1932162815 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHUNDRU | ||||||||
FirstName: | SRIKRISHNA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10825 E KESWICK RD | ||||||||
Address2: | APT 236 | ||||||||
City: | PHILADELPHIA | ||||||||
State: | PA | ||||||||
PostalCode: | 191544134 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2158211163 | ||||||||
FaxNumber: | 3602527131 | ||||||||
Practice Location | |||||||||
Address1: | 1771 W ROMNEYA DR | ||||||||
Address2: | SUITE - C | ||||||||
City: | ANAHEIM | ||||||||
State: | CA | ||||||||
PostalCode: | 928011817 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7145203000 | ||||||||
FaxNumber: | 7145205742 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/10/2006 | ||||||||
LastUpdateDate: | 06/15/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A92748 | CA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.