Individual
DR. MUDJIANTO CHANDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18370 BURBANK BLVD, SUITE 607, TARZANA, CA 91356-2804
(818) 709-8161
(818) 709-8160
Mailing address
18370 BURBANK BLVD, SUITE 607, TARZANA, CA 91356-2804
(818) 709-8161
(818) 709-8160
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
CA
05
—
00A521980
—
CA
01
—
A52198
BLUE CROSS
CA
01
—
A52198
OTHER
—
01
—
P92709600
OXFORD
—
Enumeration date
03/19/2007
Last updated
09/11/2025
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