MEDICARE: DR. ASHOK SUNDER RAJ M.D.

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	207RN0300X	Nephrology Physician	A41453	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00A414530	OTHER	CA	BLUE SHIELD PROVIDER #

General Provider Information

NPI Number	:	1093744070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHOK SUNDER RAJ M.D.

Provider Business Mailing Address
First Line	:	301 S FAIR OAKS AVE STE 405
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-2562
Country	:	US
Telephone Number	:	626-794-7075
Fax Number	:	626-404-7545

Provider Business Practice Location Address
First Line	:	301 S FAIR OAKS AVE STE 405
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-2562
Country	:	US
Telephone Number	:	626-794-7075
Fax Number	:	626-404-7545

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	03/06/2026

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