Healthcare Provider Details

I. General information

NPI: 1053691766
Provider Name (Legal Business Name): SUNDARAM FAMILY MEDICAL CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 E FLORENCE AVE
HUNTINGTON PARK CA
90255-5827
US

IV. Provider business mailing address

3001 E FLORENCE AVE
HUNTINGTON PARK CA
90255-5827
US

V. Phone/Fax

Practice location:
  • Phone: 323-589-0927
  • Fax:
Mailing address:
  • Phone: 323-589-0927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA67659
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA19004
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20A7566
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberPA19004
License Number StateCA

VIII. Authorized Official

Name: MR. JAWAHAR SUNDARAM
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 323-589-0927