Healthcare Provider Details

I. General information

NPI: 1497440721
Provider Name (Legal Business Name): TANAPONG JAMES SHUGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CLARIBEL RD
RIVERBANK CA
95367-9004
US

IV. Provider business mailing address

1901 CLARIBEL RD
RIVERBANK CA
95367-9004
US

V. Phone/Fax

Practice location:
  • Phone: 209-452-3121
  • Fax: 209-458-5740
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: