Provider Demographics
NPI:1417055872
Name:CHAUDHARY, SANDEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:
Last Name:CHAUDHARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24012 CALLE DE LA PLATA
Mailing Address - Street 2:345
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3621
Mailing Address - Country:US
Mailing Address - Phone:949-770-4177
Mailing Address - Fax:949-770-9639
Practice Address - Street 1:24012 CALLE DE LA PLATA
Practice Address - Street 2:345
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3621
Practice Address - Country:US
Practice Address - Phone:949-770-4177
Practice Address - Fax:949-770-9639
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CAA66677174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA66677COtherMEDICARE PPIN #
CAWA66677BMedicare ID - Type Unspecified
CAH55376Medicare UPIN