Provider Demographics
NPI:1700841194
Name:CHUNDU, RUPA (MD)
Entity Type:Individual
Prefix:DR
First Name:RUPA
Middle Name:
Last Name:CHUNDU
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 1:4747 N 7TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3653
Mailing Address - Country:US
Mailing Address - Phone:602-279-7655
Mailing Address - Fax:602-264-1806
Practice Address - Street 1:3001 N 33RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-5202
Practice Address - Country:US
Practice Address - Phone:602-353-0703
Practice Address - Fax:602-353-0715
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ206382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ126830Medicaid
AZ20638OtherBOARD OF MEDICAL EXAMINER
G01486Medicare UPIN