Provider Demographics
NPI:1811278435
Name:NIRANJAN, REMYA
Entity type:Individual
Prefix:DR
First Name:REMYA
Middle Name:
Last Name:NIRANJAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REMYA
Other - Middle Name:
Other - Last Name:VENKITASUBRAMONIA IYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46 E STEFANO AVE
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95391-8232
Mailing Address - Country:US
Mailing Address - Phone:408-439-3661
Mailing Address - Fax:
Practice Address - Street 1:7970 LANDER AVE
Practice Address - Street 2:
Practice Address - City:HILMAR
Practice Address - State:CA
Practice Address - Zip Code:95324-8350
Practice Address - Country:US
Practice Address - Phone:209-262-1819
Practice Address - Fax:209-262-1817
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA607651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty