Healthcare Provider Details

I. General information

NPI: 1992739460
Provider Name (Legal Business Name): BASIT IQBAL CHAUDHRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA #420
LOS ANGELES CA
90095
US

IV. Provider business mailing address

FILE #55737
LOS ANGELES CA
90074
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-8272
  • Fax:
Mailing address:
  • Phone: 310-301-8708
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA74857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: