Healthcare Provider Details

I. General information

NPI: 1932513116
Provider Name (Legal Business Name): RUSTUM KARANJIA MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S FAIR OAKS AVE
PASADENA CA
91105-2613
US

IV. Provider business mailing address

800 FAIRMOUNT AVE
PASADENA CA
91105-3150
US

V. Phone/Fax

Practice location:
  • Phone: 626-817-4747
  • Fax: 626-817-4748
Mailing address:
  • Phone: 626-817-4701
  • Fax: 626-817-4702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number130726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: