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General NPI Number Information
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NPI Number | 1992039473
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Entity Type | Organization
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Legal Business Name | SUNDARAM FAMILY MEDICAL CLINIC INC.
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Dates
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Enumeration Date | 09/30/2009
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 9217 WHITTIER BLVD
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City | PICO RIVERA
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State | CA
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Zip | 90660-2450
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Country | US
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Telephone | 562-699-5888
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Fax | 562-699-2955
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Provider Business Mailing Address
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Address Line | 9217 WHITTIER BLVD
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City | PICO RIVERA
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State | CA
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Zip | 90660-2450
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Country | US
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Telephone | 562-699-5888
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Fax | 562-699-2955
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAWAHAR SUNDARAM
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Credential | M.D
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Telephone | 562-699-5888
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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 | A92178
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA15565
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA19004
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A67659
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License Number State | CA
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