Healthcare Provider Details

I. General information

NPI: 1801277751
Provider Name (Legal Business Name): SEAN JAMES JUDGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 STOCKTON BLVD
SACRAMENTO CA
95817-1418
US

IV. Provider business mailing address

2221 STOCKTON BLVD
SACRAMENTO CA
95817-1418
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3528
  • Fax: 916-734-3951
Mailing address:
  • Phone: 916-734-3528
  • Fax: 916-734-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA145320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: