Provider Demographics
NPI:1982751756
Name:THANKACHEN, SANJAI MATHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAI
Middle Name:MATHEW
Last Name:THANKACHEN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1048 IRVINE AVE # 1056
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-4602
Mailing Address - Country:US
Mailing Address - Phone:949-340-2111
Mailing Address - Fax:949-390-6519
Practice Address - Street 1:17782 COWAN STE A
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6041
Practice Address - Country:US
Practice Address - Phone:949-340-2111
Practice Address - Fax:949-722-7119
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA 1038182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry