MEDICARE: JEFFREY EDWARD SUDEITH 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	2083X0100X	Occupational Medicine Physician	25108	MN
2	207R00000X	Internal Medicine Physician	G50344	CA

General Provider Information

NPI Number	:	1649297383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY EDWARD SUDEITH M.D.

Provider Business Mailing Address
First Line	:	1 RAPALLO
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5326
Country	:	US
Telephone Number	:	949-261-5774
Fax Number	:	714-389-6973

Provider Business Practice Location Address
First Line	:	1 RAPALLO
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5326
Country	:	US
Telephone Number	:	949-261-5774
Fax Number	:	714-389-6973

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/11/2026

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