Provider Demographics
NPI:1386732816
Name:SUMCAD, JOCELYN LAO (MD)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:LAO
Last Name:SUMCAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3608
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-9511
Mailing Address - Country:US
Mailing Address - Phone:562-633-0976
Mailing Address - Fax:562-401-6247
Practice Address - Street 1:16660 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5433
Practice Address - Country:US
Practice Address - Phone:562-633-0976
Practice Address - Fax:562-401-6247
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA35157207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A351570Medicaid
CAC44160Medicare UPIN
CAA35157Medicare ID - Type Unspecified