Provider Demographics
NPI:1114037264
Name:CHHIPWADIA, AMISHA S (MD)
Entity type:Individual
Prefix:
First Name:AMISHA
Middle Name:S
Last Name:CHHIPWADIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27962 EL PORTAL DR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-2510
Mailing Address - Country:US
Mailing Address - Phone:408-429-9955
Mailing Address - Fax:
Practice Address - Street 1:311 FULLER ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1514
Practice Address - Country:US
Practice Address - Phone:240-693-3281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1978207Q00000X
HIMD-15626207Q00000X
CAA71145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A711451Medicare PIN
CAH28693Medicare UPIN