Provider Demographics
NPI:1093744070
Name:SUNDER RAJ, ASHOK (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHOK
Middle Name:
Last Name:SUNDER RAJ
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 1:2750 E WASHINGTON BLVD
Mailing Address - Street 2:# 270
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1448
Mailing Address - Country:US
Mailing Address - Phone:626-794-7075
Mailing Address - Fax:626-794-7215
Practice Address - Street 1:2750 E WASHINGTON BLVD
Practice Address - Street 2:# 270
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1448
Practice Address - Country:US
Practice Address - Phone:626-794-7075
Practice Address - Fax:626-794-7215
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41453207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A414530Medicaid
CA00A414530OtherBLUE SHIELD PROVIDER #
CAWA41453CMedicare ID - Type UnspecifiedPPIN
CAA85634Medicare UPIN