Basic Information
| Provider Information | |||||||||
| NPI: | 1780713032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NARAYANAN | ||||||||
| FirstName: | RAJNIKANTH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6622 N 91ST AVE STE 220 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853052569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027596883 | ||||||||
| FaxNumber: | 6022243315 | ||||||||
| Practice Location | |||||||||
| Address1: | 6622 N 91ST AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853052569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235474668 | ||||||||
| FaxNumber: | 6235357869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2007 | ||||||||
| LastUpdateDate: | 05/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD00041880 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | MD00041880 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 59582 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 082279 | 05 | AZ | MEDICAID |