Provider Demographics
NPI:1609968460
Name:CHUNDU, SAI (MD)
Entity Type:Individual
Prefix:
First Name:SAI
Middle Name:
Last Name:CHUNDU
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 1:770 MAGNOLIA AVE
Mailing Address - Street 2:1F
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879
Mailing Address - Country:US
Mailing Address - Phone:951-737-1917
Mailing Address - Fax:951-735-4105
Practice Address - Street 1:770 MAGNOLIA AVE
Practice Address - Street 2:1F
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879
Practice Address - Country:US
Practice Address - Phone:951-737-1917
Practice Address - Fax:951-735-4105
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA489392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E91156Medicare UPIN
00A489390Medicare ID - Type Unspecified