Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | A51443 | CA |
NPI | 1750351300 |
---|---|
Provider Name | Dr. Gangadarshni Chandramohan |
First Address | San Marino, CA 91108-2105 |
Second Address | Los Angeles, CA 90059-3019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H33020 | (02) | CA |