Healthcare Provider Details

I. General information

NPI: 1972779338
Provider Name (Legal Business Name): KAVITHA RAJARAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 03/07/2023
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21297 FOOTHILL BLVD STE 100
HAYWARD CA
94541-1554
US

IV. Provider business mailing address

21297 FOOTHILL BLVD STE 100
HAYWARD CA
94541-1554
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 NumberA97309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: