Healthcare Provider Details

I. General information

NPI: 1477650943
Provider Name (Legal Business Name): JOSEPH GNANAPRASAD RAJENDRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NUCLEAR MEDICINE, BOX 356113, UNIVERITY OF WASHINGTON 1959 NE PACIFIC STREET
SEATTLE WA
98195
US

IV. Provider business mailing address

21016 47TH AVE W
LYNNWOOD WA
98036
US

V. Phone/Fax

Practice location:
  • Phone: 206-221-4421
  • Fax:
Mailing address:
  • Phone: 425-640-9509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number33369
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: