MEDICARE: DR. CHANDANA POTARAJU MD

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	207R00000X	Internal Medicine Physician	A202261	CA

General Provider Information

NPI Number	:	1326501909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANDANA POTARAJU MD

Provider Business Mailing Address
First Line	:	9640 VENICE BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2626
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9640 VENICE BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2626
Country	:	US
Telephone Number	:	310-603-8013
Fax Number	:

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

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	07/24/2025

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