Healthcare Provider Details

I. General information

NPI: 1386900629
Provider Name (Legal Business Name): MEENAKSHI RAJAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 DOVE ST STE 130
NEWPORT BEACH CA
92660-2844
US

IV. Provider business mailing address

24552 RAYMOND WAY UNIT 1125
LAKE FOREST CA
92630-9000
US

V. Phone/Fax

Practice location:
  • Phone: 949-767-7444
  • Fax:
Mailing address:
  • Phone: 949-414-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA180337
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: