Provider Demographics
NPI:1578835187
Name:SIVANANTHAN, SURESHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESHAN
Middle Name:
Last Name:SIVANANTHAN
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 1:707 CONTINENTAL CIR
Mailing Address - Street 2:#527
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3366
Mailing Address - Country:US
Mailing Address - Phone:415-203-4755
Mailing Address - Fax:
Practice Address - Street 1:500 E REMINGTON DR
Practice Address - Street 2:NUMBER 29
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2657
Practice Address - Country:US
Practice Address - Phone:650-721-7629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF5682207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery