Healthcare Provider Details

I. General information

NPI: 1629203237
Provider Name (Legal Business Name): VARUN KASHYAP GAJENDRAN M,D, M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROADWAY ST PAVILION C, 4TH FLOOR
REDWOOD CITY CA
94063-3132
US

IV. Provider business mailing address

1704 STONE CANYON DR
ROSEVILLE CA
95661-4041
US

V. Phone/Fax

Practice location:
  • Phone: 650-721-7669
  • Fax:
Mailing address:
  • Phone: 916-580-7672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: