Healthcare Provider Details

I. General information

NPI: 1447226444
Provider Name (Legal Business Name): SUNDARARAJAN JAYACHANDRAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 12/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W THUNDERBIRD RD SUITE C300
GLENDALE AZ
85306-4660
US

IV. Provider business mailing address

4212 E MARLETTE AVE
PARADISE VALLEY AZ
85253-3960
US

V. Phone/Fax

Practice location:
  • Phone: 602-368-3045
  • Fax: 602-651-1389
Mailing address:
  • Phone: 623-546-0745
  • Fax: 623-546-0745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number14860
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: