Provider Demographics
NPI:1548885825
Name:SUDWAL, JENNIFER KAUR
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAUR
Last Name:SUDWAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 BUCKS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9507
Mailing Address - Country:US
Mailing Address - Phone:530-283-5640
Mailing Address - Fax:
Practice Address - Street 1:1065 BUCKS LAKE RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9507
Practice Address - Country:US
Practice Address - Phone:530-283-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A22713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine