Provider Demographics
NPI:1811194145
Name:CHENNAMCHETTY, VIJAY NAIDU (MD, MPH)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:NAIDU
Last Name:CHENNAMCHETTY
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:VIJAY KUMAR
Other - Middle Name:NAIDU
Other - Last Name:CHENNAMCHETTY JAYAPRAKASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:1000 BROADWAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-7417
Mailing Address - Country:US
Mailing Address - Phone:619-401-5500
Mailing Address - Fax:619-401-5454
Practice Address - Street 1:1000 BROADWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-7417
Practice Address - Country:US
Practice Address - Phone:619-401-5500
Practice Address - Fax:619-401-5454
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 951012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1228Medicare UPIN