Provider Demographics
NPI:1548239098
Name:KHANIJOU, RAJESH K (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:K
Last Name:KHANIJOU
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 1:725 W LA VETA AVE STE 210A
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4446
Mailing Address - Country:US
Mailing Address - Phone:714-744-2403
Mailing Address - Fax:714-744-0635
Practice Address - Street 1:725 W LA VETA AVE STE 210A
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4446
Practice Address - Country:US
Practice Address - Phone:714-744-2403
Practice Address - Fax:714-744-0635
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34416208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A344160Medicaid
CA00A344160Medicaid
CAA34416Medicare ID - Type Unspecified