Provider Demographics
NPI:1699968503
Name:PUDUNAGAR SUBBIAH, SHANMUGA SUNDARAM (MD)
Entity type:Individual
Prefix:
First Name:SHANMUGA SUNDARAM
Middle Name:
Last Name:PUDUNAGAR SUBBIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4039
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-4039
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:
Practice Address - Street 1:1115 S SUNSET AVE STE 200
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3940
Practice Address - Country:US
Practice Address - Phone:626-732-8390
Practice Address - Fax:626-631-0951
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25181207RH0003X
CAA119729207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology