Healthcare Provider Details

I. General information

NPI: 1265295075
Provider Name (Legal Business Name): RAJ DEDHIA, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 HYDE ST STE 602
SAN FRANCISCO CA
94109-4847
US

IV. Provider business mailing address

909 HYDE ST STE 602
SAN FRANCISCO CA
94109-4847
US

V. Phone/Fax

Practice location:
  • Phone: 415-562-4670
  • Fax:
Mailing address:
  • Phone: 415-562-4670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RAJ DEDHIA
Title or Position: CEO, PHYSICIAN
Credential: MD
Phone: 415-562-4670