Provider Demographics
NPI:1669644563
Name:KALYAN, RANJANI (MD)
Entity Type:Individual
Prefix:DR
First Name:RANJANI
Middle Name:
Last Name:KALYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RANJANI
Other - Middle Name:RAGHUNATHAN
Other - Last Name:KALYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1300 ETHAN WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2296
Mailing Address - Country:US
Mailing Address - Phone:916-679-3513
Mailing Address - Fax:916-679-3563
Practice Address - Street 1:5 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 190
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-786-7498
Practice Address - Fax:916-786-2715
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113075207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEF138ZMedicare PIN