Provider Demographics
NPI:1689227522
Name:TANUBUDDI, CHIRANJEEVI
Entity Type:Individual
Prefix:
First Name:CHIRANJEEVI
Middle Name:
Last Name:TANUBUDDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14339 WHITTIER BLVD APT 213
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2193
Mailing Address - Country:US
Mailing Address - Phone:409-291-2026
Mailing Address - Fax:
Practice Address - Street 1:826 E MISSION BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2044
Practice Address - Country:US
Practice Address - Phone:409-291-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1040501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice