Healthcare Provider Details

I. General information

NPI: 1891316386
Provider Name (Legal Business Name): SHAIRANI SUBARAJAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22481 ASPAN ST STE A
LAKE FOREST CA
92630-1648
US

IV. Provider business mailing address

808 S BEVERLY LN
ARLINGTON HEIGHTS IL
60005-2706
US

V. Phone/Fax

Practice location:
  • Phone: 949-240-2272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A23851
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.016279
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: