MEDICARE: DR. JAWAHAR SUNDARAM MD

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	207Q00000X	Family Medicine Physician	A67659	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720082100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAWAHAR SUNDARAM MD

Provider Business Mailing Address
First Line	:	987W VERNON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-3038
Country	:	US
Telephone Number	:	323-234-6300
Fax Number	:	323-234-0100

Provider Business Practice Location Address
First Line	:	987W VERNON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-3038
Country	:	US
Telephone Number	:	323-234-6300
Fax Number	:	323-234-0100

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	04/27/2021

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