Healthcare Provider Details

I. General information

NPI: 1497199798
Provider Name (Legal Business Name): TANMAI SAXENA M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 E LA PALMA AVE
ANAHEIM CA
92806-2020
US

IV. Provider business mailing address

3440 E LA PALMA AVE
ANAHEIM CA
92806-2020
US

V. Phone/Fax

Practice location:
  • Phone: 714-644-2000
  • Fax:
Mailing address:
  • Phone: 714-644-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA135574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: