Healthcare Provider Details

I. General information

NPI: 1386981967
Provider Name (Legal Business Name): SREEDHAR CHAVA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 LONG BEACH BLVD
SOUTH GATE CA
90280-2014
US

IV. Provider business mailing address

3580 SANTA ANITA AVE SUITE A
EL MONTE CA
91731-2455
US

V. Phone/Fax

Practice location:
  • Phone: 626-444-2660
  • Fax: 626-448-1002
Mailing address:
  • Phone: 626-444-2660
  • Fax: 626-448-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: SREEDHAR CHAVA
Title or Position: MD/PRESIDENT
Credential:
Phone: 626-444-2660