Provider Demographics
NPI:1497893309
Name:PONNAMMA CHENANDA, M.D., INC
Entity Type:Organization
Organization Name:PONNAMMA CHENANDA, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PONNAMMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHENANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-860-0899
Mailing Address - Street 1:101 S 1ST ST
Mailing Address - Street 2:#1000
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1938
Mailing Address - Country:US
Mailing Address - Phone:818-845-6206
Mailing Address - Fax:818-845-9774
Practice Address - Street 1:1600 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2814
Practice Address - Country:US
Practice Address - Phone:661-949-5000
Practice Address - Fax:661-951-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84213207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17139Medicare PIN
H71752Medicare UPIN