Provider Demographics
NPI:1528214707
Name:SINGH, RAVI (MD)
Entity Type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:SINGH
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 1:15405 LOS GATOS BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2500
Mailing Address - Country:US
Mailing Address - Phone:408-402-0770
Mailing Address - Fax:
Practice Address - Street 1:15405 LOS GATOS BLVD
Practice Address - Street 2:STE 104
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2500
Practice Address - Country:US
Practice Address - Phone:408-402-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1181272085R0202X
CAA1076542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA107654OtherTHE MEDICAL BOARD OF CALIFORNIA
CABV669VOtherMEDICARE PTAN
IL036.118127OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION