Provider Demographics
NPI:1407092539
Name:DR P G RAJAN MD INC
Entity Type:Organization
Organization Name:DR P G RAJAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARTHASARATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVINDARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-832-7642
Mailing Address - Street 1:75- 5591 PALANI RD STE 2002
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-8409
Mailing Address - Country:US
Mailing Address - Phone:808-887-0600
Mailing Address - Fax:808-887-6699
Practice Address - Street 1:75-5591 PALANI RD
Practice Address - Street 2:SRE 2002
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3631
Practice Address - Country:US
Practice Address - Phone:808-887-0600
Practice Address - Fax:808-887-6699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR P G RAJAN MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-18
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI624800207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A300730Medicaid
HI624800Medicaid
A87300Medicare UPIN
HI624800Medicaid