Healthcare Provider Details

I. General information

NPI: 1336374958
Provider Name (Legal Business Name): PURAB CHAWLA VISWANATH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 ETIWANDA AVE STE 228
TARZANA CA
91356-6157
US

IV. Provider business mailing address

5525 ETIWANDA AVE STE 228
TARZANA CA
91356-6157
US

V. Phone/Fax

Practice location:
  • Phone: 310-295-6317
  • Fax: 833-907-0098
Mailing address:
  • Phone: 310-295-6317
  • Fax: 833-907-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberA137256
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA137256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: