Provider Demographics
NPI:1639985203
Name:SUKHADIA, JANKI (PA-C)
Entity type:Individual
Prefix:
First Name:JANKI
Middle Name:
Last Name:SUKHADIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 N RAINWOOD CIR APT D
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1321
Mailing Address - Country:US
Mailing Address - Phone:714-234-3256
Mailing Address - Fax:
Practice Address - Street 1:5505 E SANTA ANA CANYON RD UNIT 17374
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92817-1217
Practice Address - Country:US
Practice Address - Phone:714-234-3256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant