Provider Demographics
NPI:1437199924
Name:SUDAN, NIMIT (MD)
Entity Type:Individual
Prefix:DR
First Name:NIMIT
Middle Name:
Last Name:SUDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NIMIT
Other - Middle Name:
Other - Last Name:SUDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15503 VENTURA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3115
Practice Address - Country:US
Practice Address - Phone:818-995-8044
Practice Address - Fax:818-995-8007
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55192207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology