Healthcare Provider Details

I. General information

NPI: 1588778930
Provider Name (Legal Business Name): CHANDER SHARMA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16415 COLORADO AVE STE 304
PARAMOUNT CA
90723-5053
US

IV. Provider business mailing address

16415 COLORADO AVE STE 304
PARAMOUNT CA
90723-5053
US

V. Phone/Fax

Practice location:
  • Phone: 562-531-4171
  • Fax: 562-531-3596
Mailing address:
  • Phone: 562-531-4171
  • Fax: 562-531-3596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA30135
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA30135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: