Provider Demographics
NPI:1265295075
Name:RAJ DEDHIA, MD
Entity type:Organization
Organization Name:RAJ DEDHIA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:DEDHIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-562-4670
Mailing Address - Street 1:909 HYDE ST STE 602
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4847
Mailing Address - Country:US
Mailing Address - Phone:415-562-4670
Mailing Address - Fax:
Practice Address - Street 1:909 HYDE ST STE 602
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4847
Practice Address - Country:US
Practice Address - Phone:415-562-4670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty