MEDICARE: SANJAY UDANI M.D.

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	207R00000X	Internal Medicine Physician	4301502046	MI
2	207R00000X	Internal Medicine Physician	036141765	IL
3	207R00000X	Internal Medicine Physician	A54697	CA
4	208M00000X	Hospitalist Physician	2019034404	MO
5	208M00000X	Hospitalist Physician	01084442A	IN
6	208M00000X	Hospitalist Physician	0101269836	VA
7	208M00000X	Hospitalist Physician	036141765	IL
8	208M00000X	Hospitalist Physician	A54697	CA
9	208M00000X	Hospitalist Physician	ME162676	FL

General Provider Information

NPI Number	:	1578604690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANJAY UDANI M.D.

Provider Business Mailing Address
First Line	:	5737 KANAN RD
Second Line	:	#454
City	:	AGOURA
State	:	CA
Zip	:	91301-1601
Country	:	US
Telephone Number	:	818-964-1801
Fax Number	:

Provider Business Practice Location Address
First Line	:	5737 KANAN RD
Second Line	:	#454
City	:	AGOURA
State	:	CA
Zip	:	91301-1601
Country	:	US
Telephone Number	:	818-964-1801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/22/2025

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Directions to “ SANJAY UDANI M.D.” Practice Location

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