Healthcare Provider Details

I. General information

NPI: 1649478207
Provider Name (Legal Business Name): CHAITALI MUKHERJEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 WESTWOOD PLZ
LOS ANGELES CA
90095-5012
US

IV. Provider business mailing address

221 WESTWOOD PLZ
LOS ANGELES CA
90095-4103
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-4073
  • Fax: 310-983-1172
Mailing address:
  • Phone: 310-825-4073
  • Fax: 310-983-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC54997
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC54997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: