MEDICARE: BANI CHAUDHARY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1154844819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BANI CHAUDHARY PA-C

Provider Business Mailing Address
First Line	:	224 W DRYDEN ST APT 116
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-3736
Country	:	US
Telephone Number	:	510-735-5529
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 N LAKE AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-1228
Country	:	US
Telephone Number	:	626-993-1237
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	07/24/2017

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Directions to “ BANI CHAUDHARY PA-C” Practice Location

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