Provider Demographics
NPI:1265474464
Name:RAJENDRA S SUDAN
Entity Type:Organization
Organization Name:RAJENDRA S SUDAN
Other - Org Name:TRI COUNTY CARDIOLOGY CONSULTANT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:SUDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-983-2828
Mailing Address - Street 1:1600 CREEKSIDE DRIVE
Mailing Address - Street 2:#2300
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3447
Mailing Address - Country:US
Mailing Address - Phone:916-983-2828
Mailing Address - Fax:916-983-0148
Practice Address - Street 1:1600 CREEKSIDE DRIVE
Practice Address - Street 2:#2300
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3447
Practice Address - Country:US
Practice Address - Phone:916-983-2828
Practice Address - Fax:916-983-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35386207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27768Medicare UPIN
CAZZZ20230ZMedicare PIN