Provider Demographics
NPI:1619186194
Name:RAJAN, VIKRAM (MD)
Entity Type:Individual
Prefix:
First Name:VIKRAM
Middle Name:
Last Name:RAJAN
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 1:1301 20TH ST STE 590
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2054
Mailing Address - Country:US
Mailing Address - Phone:310-315-0101
Mailing Address - Fax:310-453-4145
Practice Address - Street 1:1301 20TH ST STE 590
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2054
Practice Address - Country:US
Practice Address - Phone:310-315-0101
Practice Address - Fax:310-453-4145
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79289207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA952976030OtherGROUP TAX IDENTIFICATION
CAHW1249AMedicare PIN
CAW1249Medicare PIN
CAHW1249Medicare PIN