Healthcare Provider Details

I. General information

NPI: 1932162815
Provider Name (Legal Business Name): SRIKRISHNA CHUNDRU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 W ROMNEYA DR SUITE - C
ANAHEIM CA
92801-1817
US

IV. Provider business mailing address

10825 E KESWICK RD APT 236
PHILADELPHIA PA
19154-4134
US

V. Phone/Fax

Practice location:
  • Phone: 714-520-3000
  • Fax: 714-520-5742
Mailing address:
  • Phone: 215-821-1163
  • Fax: 360-252-7131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA92748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: