Provider Demographics
NPI:1497920920
Name:RAGHUNAND C. SASTRY, M.D., P.C.
Entity Type:Organization
Organization Name:RAGHUNAND C. SASTRY, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-272-2100
Mailing Address - Street 1:175 N JACKSON AVE
Mailing Address - Street 2:#205
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1909
Mailing Address - Country:US
Mailing Address - Phone:408-272-2100
Mailing Address - Fax:408-259-4946
Practice Address - Street 1:175 N JACKSON AVE
Practice Address - Street 2:#205
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1909
Practice Address - Country:US
Practice Address - Phone:408-272-2100
Practice Address - Fax:408-259-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71904207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A719040Medicare PIN