Provider Demographics
NPI:1417965831
Name:CHAKRABURTY SAITTA, SULAGNA CHAKRABORTY (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SULAGNA
Middle Name:CHAKRABORTY
Last Name:CHAKRABURTY SAITTA
Suffix:
Gender:F
Credentials:MD, PHD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 WILSHIRE BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2814
Mailing Address - Country:US
Mailing Address - Phone:323-361-3550
Mailing Address - Fax:323-361-8052
Practice Address - Street 1:200 UCLA MEDICAL PLZ # 265
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8344
Practice Address - Country:US
Practice Address - Phone:310-206-6581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88947208000000X
PAMD062159L207SG0205X, 208000000X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207SG0205XAllopathic & Osteopathic PhysiciansMedical GeneticsPh.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001836128Medicaid
NJ8441707Medicaid
PA046593Medicare ID - Type Unspecified
PA001836128Medicaid