Provider Demographics
NPI:1154844819
Name:CHAUDHARY, BANI (PA-C)
Entity Type:Individual
Prefix:
First Name:BANI
Middle Name:
Last Name:CHAUDHARY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W DRYDEN ST APT 116
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3736
Mailing Address - Country:US
Mailing Address - Phone:510-735-5529
Mailing Address - Fax:
Practice Address - Street 1:1800 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-1228
Practice Address - Country:US
Practice Address - Phone:626-993-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant