Provider Demographics
NPI:1144566563
Name:SHAUN E CHANDRAN M D INC
Entity Type:Organization
Organization Name:SHAUN E CHANDRAN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-833-2406
Mailing Address - Street 1:1360 W 6TH STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732
Mailing Address - Country:US
Mailing Address - Phone:310-833-2406
Mailing Address - Fax:310-519-8936
Practice Address - Street 1:1360 W 6TH STREET
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732
Practice Address - Country:US
Practice Address - Phone:310-833-2406
Practice Address - Fax:310-519-8936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty