Individual
ILANGOVAN GOVINDARAJAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., CMD
Contact information
Practice address
975 SYCAMORE AVE, KINGMAN, AZ 86409-3548
(928) 692-1900
(928) 692-7334
Mailing address
975 SYCAMORE AVE, KINGMAN, AZ 86409-3548
(928) 692-1900
(928) 692-7334
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25797
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405036
—
AZ
Enumeration date
07/20/2006
Last updated
03/21/2011
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