Provider Demographics
NPI:1184688715
Name:SUBBIAH, SHUNMUGARAJA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHUNMUGARAJA
Middle Name:
Last Name:SUBBIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BAMBOO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3336
Mailing Address - Country:US
Mailing Address - Phone:714-418-6522
Mailing Address - Fax:714-845-0746
Practice Address - Street 1:17100 EUCLID ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4004
Practice Address - Country:US
Practice Address - Phone:714-418-6522
Practice Address - Fax:714-845-0746
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72997207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A729970Medicaid
CAWA72997DMedicare PIN
CAP00287772Medicare PIN
H30699Medicare UPIN