Provider Demographics
NPI:1235457649
Name:VENKATESAN, ARUNA (MD)
Entity Type:Individual
Prefix:DR
First Name:ARUNA
Middle Name:
Last Name:VENKATESAN
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 1:751 S BASCOM AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2604
Mailing Address - Country:US
Mailing Address - Phone:408-885-6777
Mailing Address - Fax:408-885-7166
Practice Address - Street 1:450 BROADWAY ST PAVILION B
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-721-7194
Practice Address - Fax:650-721-3464
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADO NOT HAVE YET207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology