Basic Information
Provider Information
NPI: 1598979593
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THANGARAJAH
FirstName: HARIHARAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3020 CHILDRENS WAY
Address2: MC5003
City: SAN DIEGO
State: CA
PostalCode: 921234223
CountryCode: US
TelephoneNumber: 8583096300
FaxNumber:  
Practice Location
Address1: 3030 CHILDRENS WAY
Address2: SUITE 107
City: SAN DIEGO
State: CA
PostalCode: 921234232
CountryCode: US
TelephoneNumber: 8589667711
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/09/2007
LastUpdateDate: 09/29/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XA94137CAN Allopathic & Osteopathic PhysiciansSurgery 
2086S0120XA94137CAY Allopathic & Osteopathic PhysiciansSurgeryPediatric Surgery

No ID Information.


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