Provider Demographics
NPI:1841217726
Name:PRINCETON PHYSICIANS ASSOCIATES INC.
Entity Type:Organization
Organization Name:PRINCETON PHYSICIANS ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUISUN
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-288-8292
Mailing Address - Street 1:227 W VALLEY BLVD STE 298B
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3782
Mailing Address - Country:US
Mailing Address - Phone:626-288-8292
Mailing Address - Fax:626-288-4820
Practice Address - Street 1:227 W VALLEY BLVD STE 298B
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3782
Practice Address - Country:US
Practice Address - Phone:626-288-8292
Practice Address - Fax:626-288-8789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42588207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071580Medicaid
CAW13284Medicare ID - Type Unspecified
CAGR0071580Medicaid