Itsara, Sudjai
Itsara, Sudjai is an sole proprietor health care provider with primary practice located at 305 E Granger Ave Ste 201 , Modesto CA 95350-4344. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Itsara, Sudjai can be contacted via phone (209) 526-3336.Contact Information
Primary practice address
305 E Granger Ave Ste 201
Modesto CA 95350-4344
Phone: (209) 526-3336
Fax: (209) 526-3316
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | A38082 | California |
Profile Details
| NPI number | 1699767400 |
|---|---|
| LBN Legal business name | Itsara, Sudjai |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 17th, 2005 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1699767400 | NPPES |
| California | MEDICAID | 00A380820 |
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