Basic Information
| Provider Information | |||||||||
| NPI: | 1497989719 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANDNA | ||||||||
| FirstName: | SHAUN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 S 500 E STE 600 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841021971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015876705 | ||||||||
| FaxNumber: | 8017158228 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 N MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841322367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604142000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2009 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34.010554 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | OP60636579 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207R00000X | OP60636579 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 34 010554 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RT0003X | 10552711-1204 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology |
No ID Information.