Provider Demographics
NPI:1922049394
Name:CHUDNOVSKY, VADIM (MD)
Entity Type:Individual
Prefix:DR
First Name:VADIM
Middle Name:
Last Name:CHUDNOVSKY
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 1:816 W ACEQUIA AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6126
Mailing Address - Country:US
Mailing Address - Phone:559-627-6363
Mailing Address - Fax:
Practice Address - Street 1:2601 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3206
Practice Address - Country:US
Practice Address - Phone:714-633-0011
Practice Address - Fax:714-835-3287
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA486582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A486580Medicaid
CAW19715Medicare PIN
CA00A486580Medicaid
CAWA48658GGMedicare PIN