Provider Type Icon

DR. MUDJIANTO CHANDRA M.D. NPI 1225152515


NPI Information

NPI: 1225152515
Provider Name: DR. MUDJIANTO CHANDRA, M.D.
Classification: Surgery - 208600000X
Entity Type: Individual

PECOS Registration: Yes

Address:
18370 BURBANK BLVD
SUITE 607
TARZANA, CA
ZIP 91356
Phone: (818) 709-8161
Get Directions

DR. Mudjianto Chandra, M.D. is a surgery in Tarzana, CA with 41 years of experience. The provider is a general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. DR. Mudjianto Chandra, M.D. NPI is 1225152515. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

18370 BURBANK BLVD
SUITE 607
TARZANA, CA
ZIP 91356-804
Phone: (818) 709-8161
Fax: (818) 709-8160

The NPI 1225152515 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/19/2007 and was last updated on 7/9/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208600000XSurgeryA52198CALIFORNIAYes
2208C00000XColon & Rectal SurgeryA52198CALIFORNIAX

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1A52198OTHEROTHER
200A521980MEDICAIDCALIFORNIA
3A52198OTHERCALIFORNIABLUE CROSS
4A52198MEDICARE PINCALIFORNIA
5P92709600OTHEROXFORD
6G70078MEDICARE UPINCALIFORNIA
700A521980OTHERCALIFORNIABLUE SHIELD
8A52198OTHERTRICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.