Mudjianto Chandra, M.D., INC.
Colon & Rectal Surgery in Tarzana, CA. Organization (NPI-2).
NPI number1083658827
StatusActive
Last updated in NPPESSep 11, 2025
Details
- NPI
- 1083658827
- Entity type
- Organization (NPI-2)
- Legal business name
- Mudjianto Chandra, M.D., INC.
- Organization subpart
- No
- Enumeration date
- Jun 15, 2006
- Last updated
- Sep 11, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208C00000X | Colon & Rectal Surgery | A52198 | CA | Yes |
| 208600000X | Surgery | A52198 | CA |
Practice location
18370 Burbank BlvdSuite 607
Tarzana, CA 91356-2804
Phone 818-708-1004 · Fax 818-342-2141
Mailing address
18370 Burbank BlvdSuite 607
Tarzana, CA 91356-2804
Phone 818-708-1004 · Fax 818-342-2141
Authorized official
Mudjianto Chandra
President
8187081004
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