Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | A40967 | CA |
NPI | 1033123971 |
---|---|
Provider Name | Pundari K Chemitiganti |
First Address | Huntington Beach, CA 92648-1544 |
Second Address | Huntington Beach, CA 92648-2996 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 17/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A29258 | (02) |