MEDICARE: ANIRUDH VIJAY CHANDRA DO

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	207RN0300X	Nephrology Physician	20A19111	CA
2	208M00000X	Hospitalist Physician	87906	SC
3	207R00000X	Internal Medicine Physician	20A19111	CA

General Provider Information

NPI Number	:	1255837597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANIRUDH VIJAY CHANDRA DO

Provider Business Mailing Address
First Line	:	853 COMMODORE DR APT 550
Second Line	:
City	:	SAN BRUNO
State	:	CA
Zip	:	94066-2441
Country	:	US
Telephone Number	:	925-471-1908
Fax Number	:	925-204-2149

Provider Business Practice Location Address
First Line	:	1501 TROUSDALE DR
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-4506
Country	:	US
Telephone Number	:	925-471-1908
Fax Number	:	925-204-2149

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

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	06/04/2026

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