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General NPI Number Information
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NPI Number | 1851218259
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Entity Type | Organization
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Legal Business Name | GIDUMAL MD PC
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/06/2026
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Provider Practice Location Address
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Address Line | 11820 MAYFIELD AVE APT 215
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City | LOS ANGELES
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State | CA
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Zip | 90049-5771
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Country | US
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Telephone | 646-801-2480
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Fax | 646-801-2480
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Provider Business Mailing Address
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Address Line | 11820 MAYFIELD AVE APT 215
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City | LOS ANGELES
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State | CA
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Zip | 90049-5771
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Country | US
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Telephone | 646-801-2480
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Fax | 646-801-2480
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Authorized Official
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Title or Position | OWNER
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Name | SUNDER GIDUMAL
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Credential | MD
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Telephone | 917-566-6720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number |
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License Number State |
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