Provider Demographics
NPI:1053488114
Name:CHEEMA, CHANDAN D S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDAN
Middle Name:D S
Last Name:CHEEMA
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 1:6608 MERCY CT STE B
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3171
Mailing Address - Country:US
Mailing Address - Phone:916-241-9844
Mailing Address - Fax:916-241-9845
Practice Address - Street 1:1215 PLUMAS ST STE 1300B
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3456
Practice Address - Country:US
Practice Address - Phone:530-763-1900
Practice Address - Fax:530-763-1904
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47747207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47747OtherMEDI-CAL
CA0A477470OtherMEDICAL
CA0A477470Medicare ID - Type Unspecified