Provider Demographics
NPI:1750314993
Name:EASWARAN, CHITTUR (MD)
Entity type:Individual
Prefix:DR
First Name:CHITTUR
Middle Name:
Last Name:EASWARAN
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 1:8420 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1054
Mailing Address - Country:US
Mailing Address - Phone:714-527-6460
Mailing Address - Fax:714-527-5012
Practice Address - Street 1:3400 W BALL RD STE 104
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3735
Practice Address - Country:US
Practice Address - Phone:714-527-6460
Practice Address - Fax:714-527-5012
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29301207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91185Medicare UPIN
CAG29301AMedicare ID - Type Unspecified