MUDJIANTO CHANDRA M.D. INC. NPI 1083658827

NPI Information

NPI: 1083658827
Provider Name: MUDJIANTO CHANDRA, M.D., INC.
Classification: Colon & Rectal Surgery - 208C00000X
Entity Type: Organization
Address: 18370 BURBANK BLVD
SUITE 607
TARZANA, CA
ZIP 91356
Phone: (818) 708-1004

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NPI Details

MUDJIANTO CHANDRA, M.D., INC. is a colon rectal surgery in Tarzana, CA. The provider is a colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary and female reproductive system) involved with primary intestinal disease. MUDJIANTO CHANDRA, M.D., INC. NPI is 1083658827. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

18370 BURBANK BLVD
SUITE 607
TARZANA, CA
ZIP 91356-804
Phone: (818) 708-1004
Fax: (818) 342-2141

The provider's authorized official is Mudjianto Chandra .
The authorized official title is President and has the following contact phone number (818) 708-1004.

The enumeration date for this NPI number is 6/15/2006 and was last updated on 9/11/2025.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208600000X	Surgery		A52198	CALIFORNIA	No
2	208C00000X	Colon & Rectal Surgery		A52198	CALIFORNIA	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00A521980	OTHER		BLUE SHIELD
2	P92709600	OTHER		OXFORD INSURANCE
3	00A521980	MEDICAID	CALIFORNIA
4	A52198	OTHER		PRIVATE INSURANCE PIN

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: 11/21/2025

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