Provider Demographics
NPI:1699740944
Name:SUD, HARJIT J (MD)
Entity type:Individual
Prefix:DR
First Name:HARJIT
Middle Name:J
Last Name:SUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1090
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-1090
Mailing Address - Country:US
Mailing Address - Phone:209-334-1800
Mailing Address - Fax:209-334-1430
Practice Address - Street 1:1617 N CALIFORNIA ST STE 2A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6117
Practice Address - Country:US
Practice Address - Phone:209-466-8546
Practice Address - Fax:209-466-3335
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA30647174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A306470Medicaid
CA1386636165OtherGROUP NPI
CA00A306470Medicaid
CA00A306470Medicaid
CAA87433Medicare UPIN