Healthcare Provider Details

I. General information

NPI: 1790734648
Provider Name (Legal Business Name): DEEPAK KUMAR RAJPOOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BLDG. 56, SUITE 600
ORANGE CA
92868-3201
US

IV. Provider business mailing address

9 CANDELA
IRVINE CA
92620-1823
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-6815
  • Fax: 714-456-8942
Mailing address:
  • Phone: 714-456-6815
  • Fax: 714-456-8942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberA48316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: