Provider Demographics
NPI:1225146293
Name:KANDASWAMY, CHITRA (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:CHITRA
Middle Name:
Last Name:KANDASWAMY
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:DR
Other - First Name:CHITRA
Other - Middle Name:
Other - Last Name:KANDASWAMY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MDMPH
Mailing Address - Street 1:1243 E SPRUCE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3379
Mailing Address - Country:US
Mailing Address - Phone:559-326-7659
Mailing Address - Fax:559-326-7498
Practice Address - Street 1:1243 E SPRUCE AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3379
Practice Address - Country:US
Practice Address - Phone:559-326-7659
Practice Address - Fax:559-326-7498
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92981207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A929810Medicaid
CA00A929810Medicare PIN
CAL46499Medicare UPIN