Provider Demographics
NPI:1043276900
Name:CHANDAK, PUNEET (MD)
Entity Type:Individual
Prefix:DR
First Name:PUNEET
Middle Name:
Last Name:CHANDAK
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 1:333 SANTANA ROW
Mailing Address - Street 2:APT 223
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2000
Mailing Address - Country:US
Mailing Address - Phone:415-595-8687
Mailing Address - Fax:
Practice Address - Street 1:2191 MOWRY AVE
Practice Address - Street 2:SUITE 500-H
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1725
Practice Address - Country:US
Practice Address - Phone:415-595-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79514207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ05957ZOtherMEDICARE GROUP ID
CAH70546Medicare UPIN
CA00A795141Medicare PIN