Healthcare Provider Details

I. General information

NPI: 1073608121
Provider Name (Legal Business Name): J CHANDRASEKHAR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 TRUXTUN AVE STE 120A
BAKERSFIELD CA
93309-0679
US

IV. Provider business mailing address

PO BOX 20324
BAKERSFIELD CA
93390-0324
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-1352
  • Fax: 661-704-4238
Mailing address:
  • Phone: 661-327-1352
  • Fax: 661-704-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA89686
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA89686
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA89686
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA89686
License Number StateCA

VIII. Authorized Official

Name: JAYARAMAN CHANDRASEKHAR
Title or Position: OWNER
Credential: MD
Phone: 661-327-1352