Provider Demographics
NPI:1205909637
Name:ALLEGAKOEN, CLARENCE PREMRAJ (MD)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:PREMRAJ
Last Name:ALLEGAKOEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10576 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3816
Mailing Address - Country:US
Mailing Address - Phone:650-793-4207
Mailing Address - Fax:408-861-0682
Practice Address - Street 1:2500 GRANT RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4302
Practice Address - Country:US
Practice Address - Phone:650-793-4207
Practice Address - Fax:408-861-0682
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A53837OtherMEDICAL LICENCE NUMBER
CA00A538370Medicare ID - Type Unspecified
CA0A53837OtherMEDICAL LICENCE NUMBER