Provider Demographics
NPI:1821050642
Name:DUDEJA, DEEP R (MD)
Entity Type:Individual
Prefix:
First Name:DEEP
Middle Name:R
Last Name:DUDEJA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:121 W WHITTIER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3893
Mailing Address - Country:US
Mailing Address - Phone:562-694-2500
Mailing Address - Fax:562-694-2577
Practice Address - Street 1:121 W WHITTIER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3893
Practice Address - Country:US
Practice Address - Phone:562-694-2500
Practice Address - Fax:562-694-2577
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-01-29
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Provider Licenses
StateLicense IDTaxonomies
CAG83764207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G837640Medicaid
CA00G837640Medicaid
WG83764NMedicare PIN