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General NPI Number Information
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NPI Number | 1700339561
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Entity Type | Organization
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Legal Business Name | JENNIFER SUDARSKY MD A PROFESSIONAL CORP
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 11860 WILSHIRE BLVD SUITE 200
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City | LOS ANGELES
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State | CA
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Zip | 90025-6613
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Country | US
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Telephone | 310-445-6600
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Fax | 310-445-6601
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Provider Business Mailing Address
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Address Line | 11860 WILSHIRE BLVD SUITE 200
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City | LOS ANGELES
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State | CA
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Zip | 90025-6613
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Country | US
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Telephone | 310-445-6600
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Fax | 310-445-6601
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Authorized Official
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Title or Position | DIRECTOR
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Name | RENEE GARDEN
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Credential |
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Telephone | 310-445-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A70017
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License Number State | CA
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