Provider Demographics
NPI:1154482503
Name:GOVINDARAJAN, PARTHASARATHY (MD)
Entity Type:Individual
Prefix:
First Name:PARTHASARATHY
Middle Name:
Last Name:GOVINDARAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:P
Other - Middle Name:G
Other - Last Name:RAJAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1711 W ROMNEYA DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1804
Mailing Address - Country:US
Mailing Address - Phone:714-832-7642
Mailing Address - Fax:714-832-7308
Practice Address - Street 1:75-5591 PALANI RD STE 2002
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3634
Practice Address - Country:US
Practice Address - Phone:714-832-7642
Practice Address - Fax:714-832-7308
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30073207RG0100X
HIMD.12398207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI624800Medicaid
CA00A300730Medicaid
HI624800Medicaid
CA00A300730Medicaid
CAA30073Medicare ID - Type Unspecified