Healthcare Provider Details

I. General information

NPI: 1811278435
Provider Name (Legal Business Name): DR. REMYA NIRANJAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REMYA VENKITASUBRAMONIA IYER

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7970 LANDER AVE
HILMAR CA
95324-8350
US

IV. Provider business mailing address

46 E STEFANO AVE
TRACY CA
95391-8232
US

V. Phone/Fax

Practice location:
  • Phone: 209-262-1819
  • Fax: 209-262-1817
Mailing address:
  • Phone: 408-439-3661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number60765
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: