Provider Demographics
NPI:1568776532
Name:SUSIE S K KAY M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SUSIE S K KAY M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:SAW-SIM KHOO
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-285-0185
Mailing Address - Street 1:1240 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3117
Mailing Address - Country:US
Mailing Address - Phone:626-285-0185
Mailing Address - Fax:
Practice Address - Street 1:1240 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3117
Practice Address - Country:US
Practice Address - Phone:626-285-0185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35778208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A357780Medicaid
CAA35778OtherLICENSE #
CAA35778OtherMEDICARE
CAA35778OtherMEDICARE