Provider Demographics
NPI:1063938553
Name:SUGIHARA SURGICAL SERVICES INC
Entity type:Organization
Organization Name:SUGIHARA SURGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:Q
Authorized Official - Last Name:SUGIHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-870-3033
Mailing Address - Street 1:299 W FOOTHILL BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3806
Mailing Address - Country:US
Mailing Address - Phone:909-870-3033
Mailing Address - Fax:909-870-3034
Practice Address - Street 1:811 E 11TH ST STE 207
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4872
Practice Address - Country:US
Practice Address - Phone:909-870-3033
Practice Address - Fax:909-870-3034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA142557208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty