Provider Demographics
NPI:1376881177
Name:KAPOOR, RAJAN (MBBS)
Entity Type:Individual
Prefix:DR
First Name:RAJAN
Middle Name:
Last Name:KAPOOR
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 E WARNER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3495
Mailing Address - Country:US
Mailing Address - Phone:804-610-6100
Mailing Address - Fax:480-464-0189
Practice Address - Street 1:2149 E WARNER RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3495
Practice Address - Country:US
Practice Address - Phone:804-610-6100
Practice Address - Fax:480-464-0189
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069299207RN0300X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA069299OtherGA LICENSES
GAFK4318209OtherDEA