MEDICARE: KAVITHA PANDY RAJ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0000X	Hematology (Internal Medicine) Physician	A93219	CA
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	A93219	CA
3	207R00000X	Internal Medicine Physician	A93219	CA
4	207RH0003X	Hematology & Oncology Physician	A93219	CA
5	207RX0202X	Medical Oncology Physician	A93219	CA

General Provider Information

NPI Number	:	1053450767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAVITHA PANDY RAJ MD

Provider Business Mailing Address
First Line	:	5725 W LAS POSITAS BLVD STE 100A
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94588-4054
Country	:	US
Telephone Number	:	925-734-8130
Fax Number	:

Provider Business Practice Location Address
First Line	:	5725 W LAS POSITAS BLVD STE 100A
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94588-4054
Country	:	US
Telephone Number	:	925-734-8130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	04/16/2024

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