Provider Demographics
NPI:1770799538
Name:RUGH, SOOJI LEE (MD)
Entity type:Individual
Prefix:
First Name:SOOJI
Middle Name:LEE
Last Name:RUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOOJI
Other - Middle Name:
Other - Last Name:RUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3039 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6521
Mailing Address - Country:US
Mailing Address - Phone:650-642-4680
Mailing Address - Fax:800-760-0534
Practice Address - Street 1:465 FAIRCHILD DR
Practice Address - Street 2:SUITE 112
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-2250
Practice Address - Country:US
Practice Address - Phone:650-396-8080
Practice Address - Fax:800-760-0534
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 75443207RB0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F88097Medicare UPIN