Provider Demographics
NPI:1760741649
Name:MANCHANDIA, KRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:
Last Name:MANCHANDIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KARAN
Other - Middle Name:
Other - Last Name:MANCHANDIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:290 E VERDUGO AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1331
Mailing Address - Country:US
Mailing Address - Phone:818-632-7631
Mailing Address - Fax:
Practice Address - Street 1:612 W DUARTE RD STE 801
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007
Practice Address - Country:US
Practice Address - Phone:626-600-2094
Practice Address - Fax:626-226-5827
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125432208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery