Provider Demographics
NPI:1114183043
Name:CHAUDHURI SAINI, SUMANTA SUNANDA (MD)
Entity Type:Individual
Prefix:
First Name:SUMANTA
Middle Name:SUNANDA
Last Name:CHAUDHURI SAINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUMANTA
Other - Middle Name:
Other - Last Name:CHAUDHURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1225 E LATHAM AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4423
Mailing Address - Country:US
Mailing Address - Phone:951-652-8700
Mailing Address - Fax:
Practice Address - Street 1:1225 E LATHAM AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4423
Practice Address - Country:US
Practice Address - Phone:951-652-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1114183043Medicaid
WI1114183043Medicaid