Healthcare Provider Details

I. General information

NPI: 1578835187
Provider Name (Legal Business Name): SURESHAN SIVANANTHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E REMINGTON DR NUMBER 29
SUNNYVALE CA
94087-2657
US

IV. Provider business mailing address

707 CONTINENTAL CIR #527
MOUNTAIN VIEW CA
94040-3366
US

V. Phone/Fax

Practice location:
  • Phone: 650-721-7629
  • Fax:
Mailing address:
  • Phone: 415-203-4755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberF5682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: