Provider Demographics
NPI:1891092086
Name:CHANCHAL DEWAN, MD.,F.A.A.P.,INC.
Entity Type:Organization
Organization Name:CHANCHAL DEWAN, MD.,F.A.A.P.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANCHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-690-4075
Mailing Address - Street 1:2250 W WHITTIER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3470
Mailing Address - Country:US
Mailing Address - Phone:562-690-4075
Mailing Address - Fax:
Practice Address - Street 1:2250 W WHITTIER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3470
Practice Address - Country:US
Practice Address - Phone:562-690-4075
Practice Address - Fax:562-690-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherMEDI- CAL PROVIDER NO 00A401201