Provider Demographics
NPI:1023205077
Name:CHANDRAN, SHAUN E (MD)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:E
Last Name:CHANDRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4477 W 118TH ST STE 402
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2259
Mailing Address - Country:US
Mailing Address - Phone:310-644-1151
Mailing Address - Fax:310-644-3115
Practice Address - Street 1:4477 W 118TH ST STE 402
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2259
Practice Address - Country:US
Practice Address - Phone:310-644-1151
Practice Address - Fax:310-644-3115
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA246386207X00000X
CAA97423207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program