Provider Demographics
NPI:1720270820
Name:SAHASRANAM, PREM (MD)
Entity Type:Individual
Prefix:DR
First Name:PREM
Middle Name:
Last Name:SAHASRANAM
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:PO BOX 1669
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-1669
Mailing Address - Country:US
Mailing Address - Phone:559-587-1100
Mailing Address - Fax:559-587-9044
Practice Address - Street 1:1524 W LACEY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5965
Practice Address - Country:US
Practice Address - Phone:559-410-7801
Practice Address - Fax:559-380-2406
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91333207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A913330Medicare PIN