Provider Demographics
NPI:1326709312
Name:CHANDKI, RITA
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:CHANDKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 MCLAUGHLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3566
Mailing Address - Country:US
Mailing Address - Phone:408-497-5404
Mailing Address - Fax:
Practice Address - Street 1:2325 MCLAUGHLIN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3566
Practice Address - Country:US
Practice Address - Phone:408-497-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA107263122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program