Provider Demographics
NPI:1215966981
Name:CHANDRASEKHAR, BALA S (MD)
Entity type:Individual
Prefix:
First Name:BALA
Middle Name:S
Last Name:CHANDRASEKHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E. SANTA CLARA ST.
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7233
Mailing Address - Country:US
Mailing Address - Phone:626-447-1092
Mailing Address - Fax:626-447-4125
Practice Address - Street 1:255 E. SANTA CLARA ST.
Practice Address - Street 2:SUITE 310
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7233
Practice Address - Country:US
Practice Address - Phone:626-447-1092
Practice Address - Fax:626-447-4125
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA400652086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A400650Medicaid
CAWA40065DMedicare ID - Type Unspecified
CA00A400650Medicaid