Healthcare Provider Details

I. General information

NPI: 1992642516
Provider Name (Legal Business Name): SIMON SAJAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E 36TH AVE
ANCHORAGE AK
99508-4372
US

IV. Provider business mailing address

PO BOX 31001-4162
PASADENA CA
91110-4162
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-9229
  • Fax:
Mailing address:
  • Phone: 866-747-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number254152
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: