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Individual

INGRID N WAHJUDI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
632 W GIBSON RD, WOODLAND, CA 95695-5169
(530) 668-2600
(530) 669-3638
Mailing address
3400 DATA DR, ATTN: CREDENTIALING/PAYER ENROLLMENT, RANCHO CORDOVA, CA 95670-7956

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A145785
CA

Other

Enumeration date
05/14/2014
Last updated
08/07/2020
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