Provider Demographics
NPI:1386141232
Name:SUJAN, WILLIAM G (BS, MS, MBA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:G
Last Name:SUJAN
Suffix:
Gender:M
Credentials:BS, MS, MBA
Other - Prefix:MR
Other - First Name:PRADEEP
Other - Middle Name:G
Other - Last Name:SUJAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, MS, MBA
Mailing Address - Street 1:3119 S DURANGO AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4315
Mailing Address - Country:US
Mailing Address - Phone:310-815-8143
Mailing Address - Fax:
Practice Address - Street 1:3119 S DURANGO AVE APT 6
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-4315
Practice Address - Country:US
Practice Address - Phone:310-815-8143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion