Healthcare Provider Details

I. General information

NPI: 1851684930
Provider Name (Legal Business Name): RAJEEV SHUKLA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 S. FAIRMONT AVE SUITE #1
LODI CA
95240-3971
US

IV. Provider business mailing address

845 S FAIRMONT AVE STE 135
LODI CA
95240-3971
US

V. Phone/Fax

Practice location:
  • Phone: 209-242-5385
  • Fax: 209-224-8132
Mailing address:
  • Phone: 209-224-5385
  • Fax: 202-224-8132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA51690
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAJEEV SHUKLA
Title or Position: OWNER
Credential: MD
Phone: 209-224-5385