MEDICARE: DR. SHANUP CHAND GUNDECHA D.M.D.

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	122300000X	Dentist	0401414553	VA

General Provider Information

NPI Number	:	1568879831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANUP CHAND GUNDECHA D.M.D.

Provider Business Mailing Address
First Line	:	12007 EMERY LN
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-6111
Country	:	US
Telephone Number	:	919-633-1577
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 COLORADO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1062
Country	:	US
Telephone Number	:	919-633-1577
Fax Number	:

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

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	09/11/2025

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Directions to “ DR. SHANUP CHAND GUNDECHA D.M.D.” Practice Location

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