MEDICARE: CHIKKA M RAJU DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	36823	CA

General Provider Information

NPI Number	:	1528258605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIKKA M RAJU DMD

Provider Business Mailing Address
First Line	:	PO BOX 1841
Second Line	:
City	:	NORCO
State	:	CA
Zip	:	92860-0991
Country	:	US
Telephone Number	:	951-737-2683
Fax Number	:

Provider Business Practice Location Address
First Line	:	1028 E WALNUT CREEK PKWY
Second Line	:	SUITE B
City	:	WEST COVINA
State	:	CA
Zip	:	91790-3072
Country	:	US
Telephone Number	:	626-919-1393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	07/26/2007

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