Healthcare Provider Details

I. General information

NPI: 1891092086
Provider Name (Legal Business Name): CHANCHAL DEWAN, MD.,F.A.A.P.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 W WHITTIER BLVD SUITE 100
LA HABRA CA
90631-3470
US

IV. Provider business mailing address

2250 W WHITTIER BLVD SUITE 100
LA HABRA CA
90631-3470
US

V. Phone/Fax

Practice location:
  • Phone: 562-690-4075
  • Fax: 562-690-4185
Mailing address:
  • Phone: 562-690-4075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHANCHAL DEWAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-690-4075