Provider Demographics
NPI:1447258850
Name:JAYARAJ, KANDASWAMY (MD)
Entity type:Individual
Prefix:MR
First Name:KANDASWAMY
Middle Name:
Last Name:JAYARAJ
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:PO BOX 12499
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-2499
Mailing Address - Country:US
Mailing Address - Phone:409-833-6900
Mailing Address - Fax:409-833-6908
Practice Address - Street 1:3440 FANNIN ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3842
Practice Address - Country:US
Practice Address - Phone:409-833-6900
Practice Address - Fax:409-833-6908
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6963207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168936601Medicaid
G76802Medicare UPIN
TX8C6392Medicare ID - Type Unspecified
TX168936601Medicaid