Provider Demographics
NPI:1225251762
Name:MOHAMMAD A CHAUDHRY MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MOHAMMAD A CHAUDHRY MD A PROFESSIONAL CORPORATION
Other - Org Name:A PROFESSIONAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:ASIF
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-722-2260
Mailing Address - Street 1:101 E BEVERLY BLVD
Mailing Address - Street 2:STE. 401
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4317
Mailing Address - Country:US
Mailing Address - Phone:323-722-2260
Mailing Address - Fax:323-722-2130
Practice Address - Street 1:101 E BEVERLY BLVD
Practice Address - Street 2:STE. 401
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4317
Practice Address - Country:US
Practice Address - Phone:323-722-2260
Practice Address - Fax:323-722-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA54998OtherSTATE LICENSE
CAW21307Medicare PIN
CAG56328Medicare UPIN