Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | A40065 | CA |
NPI | 1215966981 |
---|---|
Provider Name | Bala S Chandrasekhar |
First Address | Arcadia, CA 91006-7233 |
Second Address | Arcadia, CA 91006-7233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 27/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A400650 | (05) | CA |
A88513 | (02) |