Provider Demographics
NPI:1679992986
Name:CHANDRA, PIYANKA ESTELLE
Entity type:Individual
Prefix:
First Name:PIYANKA
Middle Name:ESTELLE
Last Name:CHANDRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 HOSPITAL PKWY STE 706
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1102
Mailing Address - Country:US
Mailing Address - Phone:408-972-7679
Mailing Address - Fax:866-502-3264
Practice Address - Street 1:275 HOSPITAL PKWY STE 706
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1102
Practice Address - Country:US
Practice Address - Phone:408-972-7679
Practice Address - Fax:866-502-3264
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA140519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPC3232267556Medicaid