Healthcare Provider Details

I. General information

NPI: 1619147915
Provider Name (Legal Business Name): KRISHDEEP CHADHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD SUITE 478
PHOENIX AZ
85037-3328
US

IV. Provider business mailing address

9305 W THOMAS RD STE 478
PHOENIX AZ
85037-3375
US

V. Phone/Fax

Practice location:
  • Phone: 623-236-8507
  • Fax: 623-236-8508
Mailing address:
  • Phone: 623-236-8507
  • Fax: 623-236-8508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA129186
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number247585
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number42491
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number74428
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number74428
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35C.002950
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: