Provider Demographics
NPI:1588778930
Name:SHARMA, CHANDER (MD)
Entity type:Individual
Prefix:
First Name:CHANDER
Middle Name:
Last Name:SHARMA
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 1:16415 COLORADO AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5053
Mailing Address - Country:US
Mailing Address - Phone:562-531-4171
Mailing Address - Fax:562-531-3596
Practice Address - Street 1:16415 COLORADO AVE STE 304
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5053
Practice Address - Country:US
Practice Address - Phone:562-531-4171
Practice Address - Fax:562-531-3596
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30135207Q00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A30135Medicaid
330206637OtherTAX I D
CAA84049Medicare UPIN
CAA84049Medicare UPIN