Provider Demographics
NPI:1710956701
Name:NIRANJANKUMAR, MYLAPORE S (MD)
Entity Type:Individual
Prefix:
First Name:MYLAPORE
Middle Name:S
Last Name:NIRANJANKUMAR
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 1:2110 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3752
Mailing Address - Country:US
Mailing Address - Phone:916-536-2500
Mailing Address - Fax:916-780-3904
Practice Address - Street 1:2110 PROFESSIONAL DR
Practice Address - Street 2:SUITE 120
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3752
Practice Address - Country:US
Practice Address - Phone:916-536-2500
Practice Address - Fax:916-780-3904
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117451207R00000X
NY002158208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02600824Medicaid
NY02600824Medicaid
NYI15174Medicare UPIN
NYRA4152Medicare PIN