Individual provider Active NPI

Paul Sucgang, D.O.

  • Family Medicine Physician
  • San Gabriel, CA
National Provider Identifier
1205843711
Registry record updated Jun 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A9629 Issued in CA
Practice address
207 S Santa Anita St Ste G18
San Gabriel, CA 91776-1147
Phone
(626) 389-8448
Fax
(626) 768-7585
NPI assigned
Aug 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A9629 CA Primary

Addresses

Primary practice location

207 S Santa Anita St Ste G18
San Gabriel, CA 91776-1147

Mailing address

207 S Santa Anita St Ste G18
San Gabriel, CA 91776-1147
Phone (626) 389-8448

Other identifiers 1

IdentifierTypeStateIssuer
1508178930MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
9629CAMDMental Health Counselor
20A9629CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SGV Family Medical Group, Inc Family Medicine Current Accepting new patients

Locations

416 W Las Tunas Dr
Ste 201
San Gabriel, CA 91776
Phone (626) 289-8598

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749772800000",
    "number": "1205843711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 S SANTA ANITA ST STE G18",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917761147",
            "telephone_number": "626-389-8448",
            "fax_number": "626-768-7585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 S SANTA ANITA ST STE G18",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917761147",
            "telephone_number": "626-389-8448",
            "fax_number": "626-768-7585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUCGANG",
        "first_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A9629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508178930",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Gabriel, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.