Provider Demographics
NPI:1184612061
Name:GOVINDARAJAN, SUDHA (MD)
Entity type:Individual
Prefix:
First Name:SUDHA
Middle Name:
Last Name:GOVINDARAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E BEVERLY BLVD
Mailing Address - Street 2:STE 302
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4300
Mailing Address - Country:US
Mailing Address - Phone:323-728-8181
Mailing Address - Fax:323-724-9725
Practice Address - Street 1:101 E BEVERLY BLVD
Practice Address - Street 2:STE 302
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4300
Practice Address - Country:US
Practice Address - Phone:323-728-8181
Practice Address - Fax:323-724-9725
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A88374Medicare UPIN
A88374Medicare UPIN
CA00A363700Medicaid