Provider Demographics
NPI:1205022084
Name:RAJA, WASIM H (MD)
Entity Type:Individual
Prefix:DR
First Name:WASIM
Middle Name:H
Last Name:RAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 WARNER AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7500
Mailing Address - Country:US
Mailing Address - Phone:714-486-3477
Mailing Address - Fax:833-334-0495
Practice Address - Street 1:11100 WARNER AVE STE 110
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7500
Practice Address - Country:US
Practice Address - Phone:714-486-3477
Practice Address - Fax:833-334-0495
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110055207R00000X
NE24295207R00000X
TXS5744207R00000X
NJ25MA10681000207R00000X
CODR.0062832207R00000X, 208M00000X
WAMD61157145207R00000X
CAA110055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA110055Medicaid