Provider Demographics
NPI:1588639314
Name:TAO, SUEHONG (MD)
Entity Type:Individual
Prefix:DR
First Name:SUEHONG
Middle Name:
Last Name:TAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W CENTER STREET PROMENADE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3960
Mailing Address - Country:US
Mailing Address - Phone:714-449-4800
Mailing Address - Fax:714-449-4956
Practice Address - Street 1:17083 MAIN ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6075
Practice Address - Country:US
Practice Address - Phone:760-241-6666
Practice Address - Fax:760-947-5619
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073327L208000000X
NY222009208000000X
CAC150655208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018489060003Medicaid
NY02407312Medicaid
H85059Medicare UPIN
PA0018489060003Medicaid