NPIMap

Organization Active NPI

Jennifer Sudarsky MD a Professional Corp

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1700339561
Registry record updated Aug 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A70017 Issued in CA
Legal business name
JENNIFER SUDARSKY MD A PROFESSIONAL CORP
Practice address
11860 Wilshire Blvd
Suite 200
Los Angeles, CA 90025-6613
Phone
(310) 445-6600
Fax
(310) 445-6601
NPI assigned
Jul 28, 2016
Last updated
Aug 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2016

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

Authorized official

Name
Renee Garden
Title
Director
Phone
(310) 445-6600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A70017 CA Primary

Addresses

Primary practice location

11860 Wilshire Blvd
Suite 200
Los Angeles, CA 90025-6613

Mailing address

11860 Wilshire Blvd
Suite 200
Los Angeles, CA 90025-6613
Phone (310) 445-6600

National Provider Directory

National Provider Directory

Locations

11860 Wilshire Blvd
Ste 200
Los Angeles, CA 90025
Phone (310) 315-9101

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1469664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472515200000",
    "number": "1700339561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11860 WILSHIRE BLVD",
            "address_2": "SUITE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900256613",
            "telephone_number": "310-445-6600",
            "fax_number": "310-445-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11860 WILSHIRE BLVD",
            "address_2": "SUITE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900256613",
            "telephone_number": "310-445-6600",
            "fax_number": "310-445-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER SUDARSKY MD A PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-28",
        "last_updated": "2016-08-30",
        "status": "A",
        "authorized_official_last_name": "GARDEN",
        "authorized_official_first_name": "RENEE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "310-445-6600"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A70017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; 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.