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General NPI Number Information
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NPI Number | 1922378777
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Entity Type | Individual
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Provider Name | SURIN SRIKUREJA DO
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Gender | Male
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 5685 MAIN STREET
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City | KELSEYVILLE
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State | CA
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Zip | 94551
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Country | US
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Telephone | 701-520-8555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4001
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City | YOUNTVILLE
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State | CA
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Zip | 94599-4001
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Country | US
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Telephone | 701-520-8555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 20A5393
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License Number State | CA
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