Healthcare Provider Details

I. General information

NPI: 1164510145
Provider Name (Legal Business Name): RAVI CHANDRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1734 FILLMORE ST
SAN FRANCISCO CA
94115-3130
US

IV. Provider business mailing address

95 RED ROCK WAY M305
SAN FRANCISCO CA
94131-1773
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-5955
  • Fax:
Mailing address:
  • Phone: 415-824-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA81932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: