Provider Demographics
NPI:1356906937
Name:SGV FAMILY MEDICAL GROUP, INC
Entity type:Organization
Organization Name:SGV FAMILY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUCGANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-622-2345
Mailing Address - Street 1:416 W LAS TUNAS DR STE 201
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:626-768-7585
Practice Address - Street 1:1818 N ORANGE GROVE AVE STE 307
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3028
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty