Provider Demographics
NPI:1770712663
Name:NAGARAJ M CHETTY,M.D. INC.
Entity type:Organization
Organization Name:NAGARAJ M CHETTY,M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MED/GASTROENTEROLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGARAJ
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-997-0422
Mailing Address - Street 1:15211 VANOWEN ST
Mailing Address - Street 2:#209
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3606
Mailing Address - Country:US
Mailing Address - Phone:818-997-0422
Mailing Address - Fax:818-997-1888
Practice Address - Street 1:15211 VANOWEN ST
Practice Address - Street 2:#209
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3606
Practice Address - Country:US
Practice Address - Phone:818-997-0422
Practice Address - Fax:818-997-1888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAGARAJ M CHETTY,M.D. INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-13
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89366174400000X
CAA36605174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty