| NPI | 1083658827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUDJIANTO CHANDRA President 818-708-1004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A52198) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: CA A52198) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2020-08-22 |