Healthcare Provider Details

I. General information

NPI: 1699875153
Provider Name (Legal Business Name): CHITTUR EASWARAN M.D.INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 WEST BALL ROAD , SUITE 104
ANAHEIM CA
92804
US

IV. Provider business mailing address

8420 PEBBLE BEACH COURT
BUENA PARK CA
90621
US

V. Phone/Fax

Practice location:
  • Phone: 714-527-6460
  • Fax: 714-527-5012
Mailing address:
  • Phone: 714-527-6460
  • Fax: 714-527-5012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberG29301
License Number StateCA

VIII. Authorized Official

Name: DR. CHITTUR V EASWARAN
Title or Position: PRESIDENT
Credential: M.D
Phone: 714-527-6460