Healthcare Provider Details

I. General information

NPI: 1760620231
Provider Name (Legal Business Name): PAWANDIP SINGH CHIMA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 VAN NUYS BLVD SUITE 502
SHERMAN OAKS CA
91403-1801
US

IV. Provider business mailing address

4955 VAN NUYS BLVD SUITE 502
SHERMAN OAKS CA
91403-1801
US

V. Phone/Fax

Practice location:
  • Phone: 818-325-0200
  • Fax: 818-325-0210
Mailing address:
  • Phone: 818-325-0200
  • Fax: 818-325-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: