Provider Demographics
NPI:1780798736
Name:GOPALAN, SAROJA (MD)
Entity type:Individual
Prefix:
First Name:SAROJA
Middle Name:
Last Name:GOPALAN
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 1:18432 SWARTHMORE DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4717
Mailing Address - Country:US
Mailing Address - Phone:408-885-5000
Mailing Address - Fax:
Practice Address - Street 1:500 TULLY RD
Practice Address - Street 2:PEDIATRIC CLINIC
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1917
Practice Address - Country:US
Practice Address - Phone:408-817-1419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30294208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A302940Medicaid
CA00A302940Medicaid
CAA26039Medicare UPIN