Healthcare Provider Details

I. General information

NPI: 1912460833
Provider Name (Legal Business Name): IVANA CHOUDHURY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

IV. Provider business mailing address

2823 FRESNO ST
FRESNO CA
93721-1324
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-2207
  • Fax: 559-625-7407
Mailing address:
  • Phone: 669-459-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19806
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number19806
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: