Provider Demographics
NPI:1467849901
Name:BANERJEE, SUDEEP
Entity Type:Individual
Prefix:
First Name:SUDEEP
Middle Name:
Last Name:BANERJEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 S BARRINGTON AVE
Mailing Address - Street 2:APT 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4445
Mailing Address - Country:US
Mailing Address - Phone:559-360-9402
Mailing Address - Fax:
Practice Address - Street 1:633 S BARRINGTON AVE
Practice Address - Street 2:APT 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4445
Practice Address - Country:US
Practice Address - Phone:559-360-9402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program