Provider Demographics
NPI:1225376213
Name:PAUL SUCGANG, D.O., INC
Entity Type:Organization
Organization Name:PAUL SUCGANG, D.O., INC
Other - Org Name:ACEVEDO FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUCGANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-389-8448
Mailing Address - Street 1:416 W LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1236
Mailing Address - Country:US
Mailing Address - Phone:626-389-8448
Mailing Address - Fax:
Practice Address - Street 1:1830 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 124
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3734
Practice Address - Country:US
Practice Address - Phone:213-637-9080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty