Provider Demographics
NPI:1790746014
Name:CHOUDHARY, RANJIV S (MD)
Entity Type:Individual
Prefix:DR
First Name:RANJIV
Middle Name:S
Last Name:CHOUDHARY
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 1:41210 11TH ST W
Mailing Address - Street 2:STE G
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1447
Mailing Address - Country:US
Mailing Address - Phone:661-274-1777
Mailing Address - Fax:661-274-2777
Practice Address - Street 1:41210 11TH ST W
Practice Address - Street 2:STE G
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1447
Practice Address - Country:US
Practice Address - Phone:661-274-1777
Practice Address - Fax:661-274-2777
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41754174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A417540Medicaid
CA00A417540Medicaid
CAGB756ZMedicare PIN
CAGB756ZMedicare PIN