Provider Demographics
NPI:1780842609
Name:BANDARCHI CHAMKHALEH, BIZHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BIZHAN
Middle Name:
Last Name:BANDARCHI CHAMKHALEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23679 CALABASAS RD
Mailing Address - Street 2:601
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1502
Mailing Address - Country:US
Mailing Address - Phone:818-280-5321
Mailing Address - Fax:
Practice Address - Street 1:8841 CANOGA AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-1502
Practice Address - Country:US
Practice Address - Phone:818-280-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS32967207ZC0500X, 207ZD0900X, 207ZP0101X
CAA83490207ZP0101X, 207ZC0500X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780842609OtherMEDI CAL
CAGS108ZMedicare PIN