Healthcare Provider Details

I. General information

NPI: 1952676231
Provider Name (Legal Business Name): PUSHPA NANIK CHANDWANI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13502 MUSICK DISPENSARY
IRVINE CA
92718
US

IV. Provider business mailing address

13502 MUSICK
IRVINE CA
92618-1630
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-2675
  • Fax:
Mailing address:
  • Phone: 949-855-2675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA35123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: