Healthcare Provider Details

I. General information

NPI: 1801830963
Provider Name (Legal Business Name): SHAWN CHOWDHURY P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W F ST STE 101
ONTARIO CA
91762-3201
US

IV. Provider business mailing address

125 W F ST STE 101
ONTARIO CA
91762-3201
US

V. Phone/Fax

Practice location:
  • Phone: 909-986-4550
  • Fax:
Mailing address:
  • Phone: 909-986-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: