Provider Demographics
NPI:1376794875
Name:CORINNE SUGIHARA, M.D.
Entity Type:Organization
Organization Name:CORINNE SUGIHARA, M.D.
Other - Org Name:CORINNE SUGIHARA, M.D. INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUGIHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-644-7433
Mailing Address - Street 1:1441 AVOCADO AVE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7721
Mailing Address - Country:US
Mailing Address - Phone:949-644-7433
Mailing Address - Fax:949-644-4608
Practice Address - Street 1:1441 AVOCADO AVE
Practice Address - Street 2:SUITE 608
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7721
Practice Address - Country:US
Practice Address - Phone:949-644-7433
Practice Address - Fax:949-644-4608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66437174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF04325Medicare UPIN