Provider Demographics
NPI:1952676231
Name:CHANDWANI, PUSHPA NANIK (MD)
Entity Type:Individual
Prefix:DR
First Name:PUSHPA
Middle Name:NANIK
Last Name:CHANDWANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13502 MUSICK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1630
Mailing Address - Country:US
Mailing Address - Phone:949-855-2675
Mailing Address - Fax:
Practice Address - Street 1:13502 MUSICK DISPENSARY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92718
Practice Address - Country:US
Practice Address - Phone:949-855-2675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35123207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine