Healthcare Provider Details

I. General information

NPI: 1174979397
Provider Name (Legal Business Name): JUHI UDDIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 N VERMONT AVE
LOS ANGELES CA
90029-3529
US

IV. Provider business mailing address

374 STOCKHOLM ST
BROOKLYN NY
11237-4006
US

V. Phone/Fax

Practice location:
  • Phone: 323-454-4850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036150222
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: