Provider Demographics
NPI:1700105384
Name:CHANDRA, HEENA J
Entity Type:Individual
Prefix:DR
First Name:HEENA
Middle Name:J
Last Name:CHANDRA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:HEENA
Other - Middle Name:J
Other - Last Name:CHANDRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MD
Mailing Address - Street 1:9813 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5110
Mailing Address - Country:US
Mailing Address - Phone:323-371-7918
Mailing Address - Fax:
Practice Address - Street 1:9813 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5110
Practice Address - Country:US
Practice Address - Phone:323-371-7918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-22
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA580921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery