Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A126653 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | A126653 | CA |
NPI | 1629366190 |
---|---|
Provider Name | Dr. Anusha Chandrakanthan |
First Address | Cupertino, CA 95014-0511 |
Second Address | Palo Alto, CA 94304-1419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2011 |
Last Update Date | 05/06/2019 |