Provider Demographics
NPI:1508801044
Name:GIANCHANDANI, SUPRIYA MATHUR (MD)
Entity Type:Individual
Prefix:
First Name:SUPRIYA
Middle Name:MATHUR
Last Name:GIANCHANDANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUPRIYA
Other - Middle Name:
Other - Last Name:MATHUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1050 PACIFIC COAST HIGHWAY
Mailing Address - Street 2:KAISER SOUTH BAY
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710
Mailing Address - Country:US
Mailing Address - Phone:310-517-3174
Mailing Address - Fax:
Practice Address - Street 1:4315 DIPLOMACY DR
Practice Address - Street 2:ATTN: SHERRY REEDY
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5926
Practice Address - Country:US
Practice Address - Phone:907-729-3971
Practice Address - Fax:907-729-1542
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54613207Y00000X
AK5042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD6864Medicaid
AKMD6864Medicaid
AKH79266Medicare UPIN