=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821037581
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUWAPANG PATTUMMADITH MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2006
-----------------------------------------------------
Last Update Date | 11/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1818 N ORANGE GROVE STE 104
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91767-3028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-592-2816
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1818 N ORANGE GROVE STE 104
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91767-3028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-592-2816
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | A32823
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------