Healthcare Provider Details

I. General information

NPI: 1699181404
Provider Name (Legal Business Name): ANUPAMA CHUNDU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR BUILDING 56, SUITE 600
ORANGE CA
92868
US

IV. Provider business mailing address

2211 E ORANGEWOOD AVE UNIT 320
ANAHEIM CA
92806-6528
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7658
  • Fax:
Mailing address:
  • Phone: 714-317-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7316
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: