Provider Demographics
NPI:1083835995
Name:SUDHA GOVINDARAJAN M D A PROFESSIONAL CORP
Entity type:Organization
Organization Name:SUDHA GOVINDARAJAN M D A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVINDARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-728-8181
Mailing Address - Street 1:2614 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2310
Mailing Address - Country:US
Mailing Address - Phone:323-728-8181
Mailing Address - Fax:323-724-9725
Practice Address - Street 1:2614 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2310
Practice Address - Country:US
Practice Address - Phone:323-728-8181
Practice Address - Fax:323-724-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88374Medicare UPIN