Provider Demographics
NPI:1770586505
Name:RAJA, KALYANI POLANI (MD)
Entity type:Individual
Prefix:DR
First Name:KALYANI
Middle Name:POLANI
Last Name:RAJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7679 PICTON DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-1258
Mailing Address - Country:US
Mailing Address - Phone:214-532-7206
Mailing Address - Fax:142-227-9996
Practice Address - Street 1:7679 PICTON DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-1258
Practice Address - Country:US
Practice Address - Phone:214-532-7206
Practice Address - Fax:214-227-9996
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1287208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105337305Medicaid
TX105337306Medicaid
TXG33217Medicare UPIN
TXTXB121503Medicare PIN
TXTXB121503Medicare PIN