Healthcare Provider Details

I. General information

NPI: 1811134281
Provider Name (Legal Business Name): SAJAN EAPEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN ST STE 1730
HOUSTON TX
77030-2735
US

IV. Provider business mailing address

6560 FANNIN ST STE 1730
HOUSTON TX
77030-2735
US

V. Phone/Fax

Practice location:
  • Phone: 713-795-5511
  • Fax: 713-795-4627
Mailing address:
  • Phone: 713-795-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number050460
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberP9842
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: