Provider Demographics
NPI:1619988300
Name:THAKRAN, RAJENDER S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJENDER
Middle Name:S
Last Name:THAKRAN
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 1:14762 KINAI RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-5120
Mailing Address - Country:US
Mailing Address - Phone:760-242-0715
Mailing Address - Fax:760-242-1354
Practice Address - Street 1:14762 KINAI RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-5120
Practice Address - Country:US
Practice Address - Phone:760-242-0715
Practice Address - Fax:760-242-1354
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55039174400000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A550391Medicaid
CAG57381Medicare UPIN
CADO988ZMedicare PIN
CA00A550391Medicaid