Provider Demographics
NPI:1700023942
Name:SREEDHAR CHAVA MD INC
Entity Type:Organization
Organization Name:SREEDHAR CHAVA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SREEDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-444-2660
Mailing Address - Street 1:3580 SANTA ANITA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2455
Mailing Address - Country:US
Mailing Address - Phone:626-444-2660
Mailing Address - Fax:626-448-1002
Practice Address - Street 1:3580 SANTA ANITA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2455
Practice Address - Country:US
Practice Address - Phone:626-444-2660
Practice Address - Fax:626-448-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABR662AMedicare PIN