Provider Demographics
NPI:1730373101
Name:S PATT MD INC
Entity type:Organization
Organization Name:S PATT MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUWAPANG
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTUMMADITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-592-2816
Mailing Address - Street 1:1818 N ORANGE GROVE
Mailing Address - Street 2:STE 104
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767
Mailing Address - Country:US
Mailing Address - Phone:909-592-2816
Mailing Address - Fax:909-868-6967
Practice Address - Street 1:1818 N ORANGE GROVE
Practice Address - Street 2:STE 104
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-592-2816
Practice Address - Fax:909-868-6967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32823207ND0900X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW7627BMedicare PIN
CAA35408Medicare UPIN
C35408Medicare UPIN