Provider Demographics
NPI:1336374958
Name:VISWANATH, PURAB CHAWLA (MD)
Entity Type:Individual
Prefix:
First Name:PURAB
Middle Name:CHAWLA
Last Name:VISWANATH
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 1:7301 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1904
Mailing Address - Country:US
Mailing Address - Phone:818-264-3344
Mailing Address - Fax:818-264-3433
Practice Address - Street 1:7301 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 400
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1904
Practice Address - Country:US
Practice Address - Phone:818-264-3344
Practice Address - Fax:818-264-3433
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA137256207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5594799OtherAETNA
FL012437200Medicaid
FLHW370ZMedicare PIN
FL14U84OtherBCBS