Provider Demographics
NPI:1326055963
Name:RAJARAM, KASTHURI (MD)
Entity Type:Individual
Prefix:MRS
First Name:KASTHURI
Middle Name:
Last Name:RAJARAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KASTHURI
Other - Middle Name:
Other - Last Name:SELVANATHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21297 FOOTHILL BLVD #100
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-1552
Mailing Address - Country:US
Mailing Address - Phone:510-886-8854
Mailing Address - Fax:510-886-6709
Practice Address - Street 1:21297 FOOTHILL BLVD #100
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-1552
Practice Address - Country:US
Practice Address - Phone:510-886-8854
Practice Address - Fax:510-886-6709
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31628208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A316280Medicaid
CA00A316280Medicaid