Provider Demographics
NPI:1952459513
Name:AHLUWALIA, SONU S (MD)
Entity Type:Individual
Prefix:DR
First Name:SONU
Middle Name:S
Last Name:AHLUWALIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SANJIVENDRA
Other - Middle Name:S
Other - Last Name:AHLUWALIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:444 S SAN VICENTE BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4174
Mailing Address - Country:US
Mailing Address - Phone:310-430-1310
Mailing Address - Fax:310-870-0233
Practice Address - Street 1:444 S SAN VICENTE BLVD STE 800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4174
Practice Address - Country:US
Practice Address - Phone:310-430-1310
Practice Address - Fax:310-870-0233
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85203207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954664561OtherTAX ID
CA954664561OtherTAX ID
CAWA85203BMedicare PIN