Healthcare Provider Details

I. General information

NPI: 1205046182
Provider Name (Legal Business Name): SHAUNAK VIJAY RANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 GARNET AVE #721
SAN DIEGO CA
92109-3352
US

IV. Provider business mailing address

1804 GARNET AVE #721
SAN DIEGO CA
92109-3352
US

V. Phone/Fax

Practice location:
  • Phone: 312-863-9100
  • Fax:
Mailing address:
  • Phone: 619-740-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA117404
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036.117500
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA117404
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA117404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: