Provider Demographics
NPI:1700964657
Name:PADMANABHAN, CHICKKIAH (MD)
Entity Type:Individual
Prefix:MR
First Name:CHICKKIAH
Middle Name:
Last Name:PADMANABHAN
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 1:44215 15TH STREET WEST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5504
Mailing Address - Country:US
Mailing Address - Phone:661-945-0886
Mailing Address - Fax:661-949-5331
Practice Address - Street 1:44215 15TH STREET WEST
Practice Address - Street 2:SUITE 207
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5504
Practice Address - Country:US
Practice Address - Phone:661-945-0886
Practice Address - Fax:661-949-5331
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38887208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A388870Medicaid
CAA38887Medicare ID - Type Unspecified
CA00A388870Medicaid