Mudjianto Chandra, M.D., Inc.

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

A52198 Issued in CA

Legal business name

MUDJIANTO CHANDRA, M.D., INC.

Practice address

18370 Burbank Blvd
Suite 607
Tarzana, CA 91356-2804

Phone

(818) 708-1004

Fax

(818) 342-2141

NPI assigned

Jun 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mudjianto Chandra, M.D.NPI 1225152515

Title

President

Phone

(818) 708-1004

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mudjianto Chandra, M.D.

  • Colon & Rectal Surgery Physician
  • Tarzana, CA
  • NPI 1225152515
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1083658827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18370 BURBANK BLVD",
            "address_2": "SUITE 607",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913562804",
            "telephone_number": "818-708-1004",
            "fax_number": "818-342-2141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18370 BURBANK BLVD",
            "address_2": "SUITE 607",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913562804",
            "telephone_number": "818-708-1004",
            "fax_number": "818-342-2141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUDJIANTO CHANDRA, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "CHANDRA",
        "authorized_official_first_name": "MUDJIANTO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-708-1004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "A52198",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": "CA",
            "license": "A52198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00A521980",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD INSURANCE",
            "identifier": "P92709600",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A521980",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE INSURANCE PIN",
            "identifier": "A52198",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monica Moussanejad, DDS
• Mina Moussavian-Assadi, M.D.
• Bakhtiar Moussazadeh, MD
• Kenneth L Moy, M.D.
• Sataporn Muang-in, MD
• Marvin Mungcal
• Janeisy Muniz
• Joeleen Munoz
• Maria Fe Munoz, RNC
• Bernice Murphy

• Colon & Rectal Surgery Physician in Tarzana, CA
• Providers in Tarzana, CA by specialty
• Colon & Rectal Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.