Provider Demographics
NPI:1972645182
Name:YOGARATNAM, JAYARAJA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYARAJA
Middle Name:
Last Name:YOGARATNAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:
Other - Last Name:YOGARATNAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:341 W 2ND STREET
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1804
Mailing Address - Country:US
Mailing Address - Phone:909-885-5785
Mailing Address - Fax:909-885-3398
Practice Address - Street 1:341 W 2ND STREET
Practice Address - Street 2:SUITE #3
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1804
Practice Address - Country:US
Practice Address - Phone:909-885-5785
Practice Address - Fax:909-885-3398
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38185207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
00C381850Medicare ID - Type Unspecified
B18733Medicare UPIN