Provider Demographics
NPI:1831583483
Name:CHIDAMBARAM, AMBIKA GNANAM (MBBS)
Entity type:Individual
Prefix:DR
First Name:AMBIKA
Middle Name:GNANAM
Last Name:CHIDAMBARAM
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2516 STOCKTON BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2208
Mailing Address - Country:US
Mailing Address - Phone:916-734-3189
Mailing Address - Fax:
Practice Address - Street 1:2521 STOCKTON BLVD FL 3
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-21
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1815692080P0214X
PAMT2123272080P0214X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program