Provider Demographics
NPI:1255515383
Name:CHAVA, SREEDHAR (MD)
Entity type:Individual
Prefix:
First Name:SREEDHAR
Middle Name:
Last Name:CHAVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 SANTA ANITA AVENUE
Mailing Address - Street 2:ST # A
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731
Mailing Address - Country:US
Mailing Address - Phone:626-444-2660
Mailing Address - Fax:626-448-1002
Practice Address - Street 1:3580 SANTA ANITA AVE
Practice Address - Street 2:ST # A
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2455
Practice Address - Country:US
Practice Address - Phone:626-444-2660
Practice Address - Fax:626-448-1002
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA102291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA102291Medicaid