Individual
DR. NIRANJAN JEGANATHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11234 ANDERSON ST RM 1516, LOMA LINDA, CA 92354-2804
(909) 558-4000
(909) 558-0429
Mailing address
11234 ANDERSON ST RM 1516, LOMA LINDA, CA 92354-2804
(909) 558-4000
(909) 558-0429
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A144063
CA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
A144063
CA
207RP1001X
Pulmonary Disease Physician
A144063
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE PTAN GROUP
IL
01
—
F400306639
MEDICARE PTAN INDIVIDUAL
IL
Enumeration date
06/19/2008
Last updated
07/21/2022
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