Healthcare Provider Details

I. General information

NPI: 1780798736
Provider Name (Legal Business Name): SAROJA GOPALAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 TULLY RD PEDIATRIC CLINIC
SAN JOSE CA
95111-1917
US

IV. Provider business mailing address

18432 SWARTHMORE DR
SARATOGA CA
95070-4717
US

V. Phone/Fax

Practice location:
  • Phone: 408-817-1419
  • Fax:
Mailing address:
  • Phone: 408-885-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA30294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: