Provider Demographics
NPI:1407904089
Name:RAGHUNATHAN, CHENGALROYAN (MD)
Entity Type:Individual
Prefix:
First Name:CHENGALROYAN
Middle Name:
Last Name:RAGHUNATHAN
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 1:16660 PARAMOUNT BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5457
Mailing Address - Country:US
Mailing Address - Phone:562-663-9191
Mailing Address - Fax:562-663-9111
Practice Address - Street 1:16660 PARAMOUNT BLVD STE 202
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5457
Practice Address - Country:US
Practice Address - Phone:562-663-9191
Practice Address - Fax:562-663-9111
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA303390207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA953548420OtherTAX ID
CA00A303390Medicaid
CA953548420OtherTAX ID
CACB237010Medicare PIN