Individual
DR. MUDJIANTO CHANDRA
Active
Individual
DR. MUDJIANTO CHANDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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