Provider Demographics
NPI:1871679837
Name:R. S. RAJAH, M.D., INC.
Entity Type:Organization
Organization Name:R. S. RAJAH, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RATNASOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAJAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-895-9721
Mailing Address - Street 1:13847 E 14TH ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2632
Mailing Address - Country:US
Mailing Address - Phone:510-895-9721
Mailing Address - Fax:510-895-5283
Practice Address - Street 1:13847 E 14TH ST
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2632
Practice Address - Country:US
Practice Address - Phone:510-895-9721
Practice Address - Fax:510-895-5283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29661174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A29661020Medicaid
CAA25844Medicare UPIN
00A296610Medicare ID - Type Unspecified