Provider Demographics
NPI:1427103522
Name:RAJARATNAM, SAMUEL JOHN N (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL JOHN
Middle Name:N
Last Name:RAJARATNAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:23509 RIDGE LINE RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3008
Mailing Address - Country:US
Mailing Address - Phone:714-553-4592
Mailing Address - Fax:714-841-6775
Practice Address - Street 1:16152 BEACH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3869
Practice Address - Country:US
Practice Address - Phone:714-841-6772
Practice Address - Fax:714-841-6775
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA512072084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVERD214OtherSTAFF#