Organization
MUDJIANTO CHANDRA, M.D., INC.
Active
Organization
MUDJIANTO CHANDRA, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MUDJIANTO CHANDRA M.D. (PRESIDENT)
(818) 708-1004
Entity
Organization
Contact information
Practice address
18370 BURBANK BLVD, SUITE 607, TARZANA, CA 91356-2804
(818) 708-1004
(818) 342-2141
Mailing address
18370 BURBANK BLVD, SUITE 607, TARZANA, CA 91356-2804
(818) 708-1004
(818) 342-2141
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
A52198
CA
208C00000X
Colon & Rectal Surgery Physician
Primary
A52198
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A521980
BLUE SHIELD
—
05
—
00A521980
—
CA
01
—
A52198
PRIVATE INSURANCE PIN
—
01
—
P92709600
OXFORD INSURANCE
—
Enumeration date
06/15/2006
Last updated
09/11/2025
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