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General NPI Number Information
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NPI Number | 1063938553
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Entity Type | Organization
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Legal Business Name | SUGIHARA SURGICAL SERVICES INC
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 811 E 11TH ST STE 207
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City | UPLAND
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State | CA
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Zip | 91786-4872
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Country | US
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Telephone | 909-870-3033
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Fax | 909-870-3034
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Provider Business Mailing Address
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Address Line | 299 W FOOTHILL BLVD STE 212
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City | UPLAND
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State | CA
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Zip | 91786-3806
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Country | US
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Telephone | 909-870-3033
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Fax | 909-870-3034
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | ADAM Q SUGIHARA
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Credential | MD
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Telephone | 909-870-3033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A142557
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License Number State | CA
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