Provider Demographics
NPI:1154547719
Name:JEYANANDARAJAN, DHIRAJ (MD)
Entity type:Individual
Prefix:DR
First Name:DHIRAJ
Middle Name:
Last Name:JEYANANDARAJAN
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 1:11121 SUN CENTER DR
Mailing Address - Street 2:STE G
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6199
Mailing Address - Country:US
Mailing Address - Phone:916-631-0112
Mailing Address - Fax:916-631-1652
Practice Address - Street 1:7545 IRVINE CENTER DR
Practice Address - Street 2:200
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2932
Practice Address - Country:US
Practice Address - Phone:805-928-1731
Practice Address - Fax:805-349-8160
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA912592084N0400X
CT459602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A912590OtherBLUE CROSS BLUE SHIELD
CAAT228XMedicare PIN
CA00A912590OtherBLUE CROSS BLUE SHIELD
CAAT228YMedicare PIN