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General NPI Number Information
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NPI Number | 1942184817
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Entity Type | Organization
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Legal Business Name | CHANUKYA DASARI MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 1840 N HACIENDA BLVD STE 12
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City | LA PUENTE
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State | CA
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Zip | 91744-1143
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Country | US
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Telephone | 702-723-6588
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Fax |
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Provider Business Mailing Address
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Address Line | 1845 W 4400 S STE A1
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City | ROY
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State | UT
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Zip | 84067-3049
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Country | US
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Telephone | 702-723-6588
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DZUY LUU
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Credential | PA
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Telephone | 702-723-6588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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