Healthcare Provider Details

I. General information

NPI: 1427284066
Provider Name (Legal Business Name): VEENA VANCHINATHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLZ # 450 DEPARTMENT OF DERMATOLOGY
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 200 DEPARTMENT OF DERMATOLOGY
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-6301
  • Fax:
Mailing address:
  • Phone: 310-917-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberA126251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: