Provider Demographics
NPI:1700229721
Name:BUDIMAN, ALEX (DO)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:BUDIMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 N. BELLFLOWER BLVD.
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815
Mailing Address - Country:US
Mailing Address - Phone:562-346-2222
Mailing Address - Fax:562-546-8210
Practice Address - Street 1:2110 N. BELLFLOWER BLVD.
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815
Practice Address - Country:US
Practice Address - Phone:562-346-2222
Practice Address - Fax:562-546-8210
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0061948207Q00000X
CA20A14857207Q00000X
CODR0061948261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000174876Medicaid