Healthcare Provider Details

I. General information

NPI: 1497827745
Provider Name (Legal Business Name): SUDHAKAR V CHERUKURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 ENBORG LANE SANTA CLARA VALLEY MEDICAL CENTER
SANTA CLARA CA
95128-2648
US

IV. Provider business mailing address

2425 ENBORG LANE SANTA CLARA VALLEY MEDICAL CENTER
SANTA CLARA CA
95128-2648
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5400
  • Fax: 408-885-4055
Mailing address:
  • Phone: 408-885-5400
  • Fax: 408-885-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberA96644
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA96644
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number96644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: