Provider Demographics
NPI:1699706556
Name:RAJU, JAY S (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:S
Last Name:RAJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAGJIT
Other - Middle Name:S
Other - Last Name:RAJU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2030 FOREST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4833
Mailing Address - Country:US
Mailing Address - Phone:408-297-2416
Mailing Address - Fax:408-297-0216
Practice Address - Street 1:2030 FOREST AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4833
Practice Address - Country:US
Practice Address - Phone:408-297-2416
Practice Address - Fax:408-297-0216
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA335520207RG0100X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A335520Medicare ID - Type UnspecifiedMEDICARE PROVIDER
CAC03920Medicare UPIN