Healthcare Provider Details

I. General information

NPI: 1629207147
Provider Name (Legal Business Name): JAYAN NAGENDRAN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR FALK BLDG. CVRB. STANFORD UNIVERSITY MEDICAL CENTER
STANFORD CA
94305-2200
US

IV. Provider business mailing address

906 CLARK WAY
PALO ALTO CA
94304-2304
US

V. Phone/Fax

Practice location:
  • Phone: 650-521-1886
  • Fax: 650-725-3846
Mailing address:
  • Phone: 650-521-1886
  • Fax: 650-725-3846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA108783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: