Provider Demographics
NPI:1629050489
Name:CHANDURI, SWARNA SUNDARI (MD)
Entity Type:Individual
Prefix:DR
First Name:SWARNA
Middle Name:SUNDARI
Last Name:CHANDURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 TOWNE CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5900
Mailing Address - Country:US
Mailing Address - Phone:909-398-1550
Mailing Address - Fax:909-398-1488
Practice Address - Street 1:1910 ROYALTY DRIVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-7205
Practice Address - Country:US
Practice Address - Phone:909-630-7205
Practice Address - Fax:909-630-7380
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41753207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A417530Medicaid
CAA41753Medicare ID - Type Unspecified
CA00A417530Medicaid