Basic Information
Provider Information
NPI: 1871558288
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAKRAVORTY
FirstName: ARUNA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D., PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 325 DISTEL CIR
Address2:  
City: LOS ALTOS
State: CA
PostalCode: 940221408
CountryCode: US
TelephoneNumber: 5104982357
FaxNumber: 5104982699
Practice Location
Address1: 4050 DUBLIN BLVD
Address2:  
City: DUBLIN
State: CA
PostalCode: 945683112
CountryCode: US
TelephoneNumber: 5104982357
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/19/2006
LastUpdateDate: 05/28/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/28/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101XA61615CAY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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