Healthcare Provider Details

I. General information

NPI: 1467537340
Provider Name (Legal Business Name): AJIT VELAYUDHAN NAIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE SCVMC DEPARTMENT OF RADIOLOGY
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

751 S BASCOM AVE SCVMC DEPARTMENT OF RADIOLOGY
SAN JOSE CA
95128-2604
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-6370
  • Fax:
Mailing address:
  • Phone: 408-885-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number47572-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD60003291
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA114968
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: