Provider Demographics
NPI:1184665556
Name:RAILAN, DIVYA (MD)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:RAILAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 BRYANT ST
Mailing Address - Street 2:#597
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1704
Mailing Address - Country:US
Mailing Address - Phone:650-322-1100
Mailing Address - Fax:650-322-1115
Practice Address - Street 1:888 OAK GROVE AVE
Practice Address - Street 2:STE 14
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4432
Practice Address - Country:US
Practice Address - Phone:650-322-1100
Practice Address - Fax:650-322-1115
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88528174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI46851Medicare UPIN
CAGB854ZMedicare PIN