Provider Demographics
NPI:1831384783
Name:SUNIL SUJAN, M.D., INC.
Entity type:Organization
Organization Name:SUNIL SUJAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-351-4566
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:
Mailing Address - Fax:
Practice Address - Street 1:800 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3420
Practice Address - Country:US
Practice Address - Phone:951-736-6325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2022-08-25
Deactivation Date:2020-07-02
Deactivation Code:
Reactivation Date:2022-08-25
Provider Licenses
StateLicense IDTaxonomies
CAA63079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty