MEDICARE: ASHOK S. RAJ, M.D., INC.

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	ZZZ09908Z	OTHER	CA	BLUE SHIELD GROUP #

General Provider Information

NPI Number	:	1700815784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHOK S. RAJ, M.D., INC.

Provider Business Mailing Address
First Line	:	2750 E WASHINGTON BLVD
Second Line	:	# 270
City	:	PASADENA
State	:	CA
Zip	:	91107-1448
Country	:	US
Telephone Number	:	626-794-7075
Fax Number	:	626-794-7215

Provider Business Practice Location Address
First Line	:	2750 E WASHINGTON BLVD
Second Line	:	# 270
City	:	PASADENA
State	:	CA
Zip	:	91107-1448
Country	:	US
Telephone Number	:	626-794-7075
Fax Number	:	626-794-7215

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. ASHOK SUNDER RAJ
Credential	:	M.D.
Telephone Number	:	626-794-7075

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	09/29/2008

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