Sudjai Itsara, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A38082 Issued in CA

Practice address

305 E Granger Ave Ste 201
Modesto, CA 95350-4344

Phone

(209) 526-3336

Fax

(209) 526-3316

NPI assigned

Aug 17, 2005

Reactivated

Aug 31, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Sudjai Chaiamnuay Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sutter Gould Medical Foundation

  dba Dale Road Care Center

  • Family Medicine Physician
  • Modesto, CA
  • NPI 1326093360
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699767400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 E GRANGER AVE STE 201",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504344",
            "telephone_number": "209-526-3336",
            "fax_number": "209-526-3316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E GRANGER AVE STE 201",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504344",
            "telephone_number": "209-526-3336",
            "fax_number": "209-526-3316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ITSARA",
        "first_name": "SUDJAI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-17",
        "last_updated": "2007-07-08",
        "deactivation_date": "2006-03-23",
        "reactivation_date": "2006-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A38082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A380820",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUDJAI",
            "last_name": "CHAIAMNUAY",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elizabeth Isquierdo
• Barbara Joan Israels, MA,MFT
• Arman Israelyan, DO
• Yuri Ito, D.O.
• Kriengsak Itsara, MD
• Palepa Iulio
• Micheline Diane Iungerich, NP
• Gayle Patricia Ivy, RN
• Eric Iwata
• Sherin Hamdul Izchi

• Pediatrics Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.