Provider Demographics
NPI:1790043040
Name:SHAJAN, JOSHAN K (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHAN
Middle Name:K
Last Name:SHAJAN
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 1:212 BIBLE ST
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-1322
Mailing Address - Country:US
Mailing Address - Phone:646-652-1791
Mailing Address - Fax:888-981-1828
Practice Address - Street 1:3863 CLAIREMONT DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5831
Practice Address - Country:US
Practice Address - Phone:858-483-5570
Practice Address - Fax:858-483-5572
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53782207R00000X
CAA155675208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine