Healthcare Provider Details

I. General information

NPI: 1801283692
Provider Name (Legal Business Name): VIJAY CHANDRAN MD,RN,MBA.;
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 W WARNER AVE
SANTA ANA CA
92707-3147
US

IV. Provider business mailing address

1308 E COLORADO BLVD STE 2079
PASADENA CA
91106-1932
US

V. Phone/Fax

Practice location:
  • Phone: 213-422-5483
  • Fax:
Mailing address:
  • Phone: 213-422-4853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA171281
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberA171281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: