Organization Name: | SUNDARAM FAMILY MEDICAL CLINIC INC. |
NPI Number: | 1053691766 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAWAHAR SUNDARAM (PHYSICIAN) |
Mailing Address: | 3001 E Florence Ave Huntington Park |
State: | CA US |
Postal Code: | 902555827 |
Phone Number: | 3235890927 |
Fax Number: | |
NPI Enumeration Date: | 08/25/2011 |
NPI Last Update Date: | 08/25/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A67659 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |