Provider Demographics
NPI:1669429841
Name:CHOUDHARY, SATISH K (MD)
Entity type:Individual
Prefix:
First Name:SATISH
Middle Name:K
Last Name:CHOUDHARY
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:PO BOX 8000
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-8000
Mailing Address - Country:US
Mailing Address - Phone:909-476-6743
Mailing Address - Fax:909-581-0948
Practice Address - Street 1:7974 HAVEN AVE
Practice Address - Street 2:STE 200
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3052
Practice Address - Country:US
Practice Address - Phone:909-476-6743
Practice Address - Fax:909-581-0948
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA044578207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A445780OtherBLUESHIELD OF CALIFORNIA
CA060025151OtherRAIL ROAD MEDICARE
CA00A445781Medicaid
CA00A445780OtherBLUESHIELD OF CALIFORNIA
CAF48887Medicare UPIN