Healthcare Provider Details

I. General information

NPI: 1114858388
Provider Name (Legal Business Name): DR. VANDAN CHAVDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

3020 W MONTROSE AVE
CHICAGO IL
60618-1312
US

IV. Provider business mailing address

845 E 22ND ST APT 402
LOMBARD IL
60148-6706
US

V. Phone/Fax

Practice location:
  • Phone: 510-565-2173
  • Fax:
Mailing address:
  • Phone: 510-565-2173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: