Provider Demographics
NPI:1447226444
Name:JAYACHANDRAN, SUNDARARAJAN (MD)
Entity type:Individual
Prefix:
First Name:SUNDARARAJAN
Middle Name:
Last Name:JAYACHANDRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 E MARLETTE AVE
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3960
Mailing Address - Country:US
Mailing Address - Phone:623-546-0745
Mailing Address - Fax:623-546-0745
Practice Address - Street 1:5750 W THUNDERBIRD RD
Practice Address - Street 2:SUITE C300
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4660
Practice Address - Country:US
Practice Address - Phone:602-368-3045
Practice Address - Fax:602-651-1389
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14860208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ79580Medicare PIN
AZA60390Medicare UPIN