Provider Demographics
NPI:1073665980
Name:JOSEPH H. SUGERMAN, M.D., INC.
Entity Type:Organization
Organization Name:JOSEPH H. SUGERMAN, M.D., INC.
Other - Org Name:KANTOR SUGERMAN, MD, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:SUGERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-274-6005
Mailing Address - Street 1:435 N BEDFORD DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4321
Mailing Address - Country:US
Mailing Address - Phone:310-274-6005
Mailing Address - Fax:310-274-3570
Practice Address - Street 1:435 N BEDFORD DR
Practice Address - Street 2:SUITE 203
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4321
Practice Address - Country:US
Practice Address - Phone:310-274-6005
Practice Address - Fax:310-274-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW4597207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW71218Medicare UPIN
CAA30995Medicare UPIN
CAA43243Medicare UPIN