Healthcare Provider Details

I. General information

NPI: 1326055963
Provider Name (Legal Business Name): KASTHURI RAJARAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASTHURI SELVANATHAN

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21297 FOOTHILL BLVD #100
HAYWARD CA
94541-1552
US

IV. Provider business mailing address

21297 FOOTHILL BLVD #100
HAYWARD CA
94541-1552
US

V. Phone/Fax

Practice location:
  • Phone: 510-886-8854
  • Fax: 510-886-6709
Mailing address:
  • Phone: 510-886-8854
  • Fax: 510-886-6709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA31628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: