Healthcare Provider Details

I. General information

NPI: 1013999218
Provider Name (Legal Business Name): PUSHAN CHOWDHURY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 KELLOGG AVE
CORONA CA
92879-3111
US

IV. Provider business mailing address

2055 KELLOGG AVE
CORONA CA
92879-3111
US

V. Phone/Fax

Practice location:
  • Phone: 186-698-4748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33097
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC55148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: