Basic Information
| Provider Information | |||||||||
| NPI: | 1376795468 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHUMAN | ||||||||
| FirstName: | SUDEEP | ||||||||
| MiddleName: | KAUR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2767 OLIVE HWY | ||||||||
| Address2: | MEDICAL STAFF OFFICE / OROVILLE HOSPITAL | ||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959666118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185285268 | ||||||||
| FaxNumber: | 9187700058 | ||||||||
| Practice Location | |||||||||
| Address1: | 2809 OLIVE HWY STE 150 | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959666133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305328180 | ||||||||
| FaxNumber: | 5305383145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2008 | ||||||||
| LastUpdateDate: | 07/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A117886 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 35.097419 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 35.097419 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | A117886 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1376795468 | 05 | CA | MEDICAID |