Provider Demographics
NPI:1598740474
Name:SUJAN, SUNIL G (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:G
Last Name:SUJAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1223 WILSHIRE BLVD
Mailing Address - Street 2:SUITE #997
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5406
Mailing Address - Country:US
Mailing Address - Phone:310-351-4566
Mailing Address - Fax:310-496-1216
Practice Address - Street 1:838 19TH ST APT 5
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-6711
Practice Address - Country:US
Practice Address - Phone:310-998-0031
Practice Address - Fax:310-496-1216
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA63079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66793Medicare UPIN