Phuphanich, Surasak

Phuphanich, Surasak is an individual health care provider with primary practice located at 8700 Beverly Blvd , West Hollywood CA 90048. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Medical Oncology, Allopathic & Osteopathic Physicians / Neurology. Allopathic & Osteopathic Physicians / Neurology is his primary health care specialty. Phuphanich, Surasak can be contacted via phone (310) 423-5000.

Contact Information

Primary practice address
8700 Beverly Blvd West Hollywood CA 90048
Phone: (310) 423-5000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Medical Oncology 207RX0202X 53514 Georgia
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 53135 Arizona
Allopathic & Osteopathic Physicians / Neurology 2084N0400X A36229 California

Profile Details

NPI number 1457469074
LBN Legal business name Phuphanich, Surasak
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 25th, 2006
Last updated Oct 3rd, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457469074 NPPES
Arizona MEDICAID 266604

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