Provider Demographics
NPI:1700061298
Name:S PATT MD INC
Entity Type:Organization
Organization Name:S PATT MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUWAPANG
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTAMMADITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-537-5810
Mailing Address - Street 1:3621 E MLK JR BL
Mailing Address - Street 2:#14
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262
Mailing Address - Country:US
Mailing Address - Phone:310-537-5810
Mailing Address - Fax:310-537-5876
Practice Address - Street 1:3621 E MLK JR BL
Practice Address - Street 2:#14
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262
Practice Address - Country:US
Practice Address - Phone:310-537-5810
Practice Address - Fax:310-537-5876
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S PATT MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-03
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32823207N00000X
CA207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC35408Medicare UPIN