MEDICARE: RAJENDRA S SUDAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	A35386	CA

General Provider Information

NPI Number	:	1265474464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAJENDRA S SUDAN

Provider Business Mailing Address
First Line	:	1600 CREEKSIDE DRIVE
Second Line	:	#2300
City	:	FOLSOM
State	:	CA
Zip	:	95630-3447
Country	:	US
Telephone Number	:	916-983-2828
Fax Number	:	916-983-0148

Provider Business Practice Location Address
First Line	:	1600 CREEKSIDE DRIVE
Second Line	:	#2300
City	:	FOLSOM
State	:	CA
Zip	:	95630-3447
Country	:	US
Telephone Number	:	916-983-2828
Fax Number	:	916-983-0148

Authorized Official
Title or Position	:	OWNER/MD
Name	:	RAJENDRA SINGH SUDAN
Credential	:	MD
Telephone Number	:	916-983-2828

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	06/26/2008

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