Provider Demographics
NPI:1669589644
Name:JEYARANJAN, THAMBIMUTTU (MD)
Entity type:Individual
Prefix:DR
First Name:THAMBIMUTTU
Middle Name:
Last Name:JEYARANJAN
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 1:284 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1733
Mailing Address - Country:US
Mailing Address - Phone:323-780-5884
Mailing Address - Fax:323-264-4628
Practice Address - Street 1:284 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1733
Practice Address - Country:US
Practice Address - Phone:323-780-5884
Practice Address - Fax:323-264-4628
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32442208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A324421Medicaid