MEDICARE: DR. SHAUNAK VIJAY RANA 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	036.117500	IL
2	207R00000X	Internal Medicine Physician	A117404	CA
3	208M00000X	Hospitalist Physician	A117404	CA
4	207RN0300X	Nephrology Physician	A117404	CA

General Provider Information

NPI Number	:	1205046182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAUNAK VIJAY RANA M.D.

Provider Business Mailing Address
First Line	:	1804 GARNET AVE
Second Line	:	#721
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3352
Country	:	US
Telephone Number	:	619-740-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1804 GARNET AVE
Second Line	:	#721
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3352
Country	:	US
Telephone Number	:	312-863-9100
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	02/18/2021

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