Surasak Phuphanich, M.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

A36229 Issued in CA

Practice address

8700 Beverly Blvd
West Hollywood, CA 90048

Phone

(310) 423-5000

NPI assigned

Aug 25, 2006

Last updated

Oct 3, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sphuphanich103496@direct.cshs.org

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

• Regents of the University of Claifornia Univ Neursciences

  • Neurology Physician
  • Orange, CA
  • NPI 1205884210
  Medicare reassignment NPD
• Livi Medical Services LLC

  dba Elevation Primary and Palliative

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1457667750
  NPD (past)

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1457469074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 512717",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900510717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8700 BEVERLY BLVD",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "90048",
            "telephone_number": "310-423-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "240 W Thomas Rd # 403",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "85013",
            "country_code": "US",
            "telephone_number": "602-406-6262",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "127 South San Vicente BLVD, Suite A6600",
            "address_2": "Cedars-Sinai Medical Center-AHSP",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "90048",
            "country_code": "US",
            "telephone_number": "310-423-8100 x36633",
            "fax_number": "310-423-8189",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHUPHANICH",
        "first_name": "SURASAK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "GA",
            "license": "53514",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "AZ",
            "license": "53135",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A36229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "266604",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Phak, MD
• Justin Hao-Nhien Pham, MD
• David Hoangtien Phan, MD
• Kyle Phan
• Pharmacy4Humanity (Ahf Pharmacy)
• Pilgrim Anesthesia Medical Corporation
• Raghavendra Pillappa, MD
• Richard Ludwig Pilsl, PHARM.D.
• Daniel Joel Pimstone, M.D.
• Pinar Wagner Dental Partnership

• Neurology Physician in West Hollywood, CA
• Providers in West Hollywood, CA by specialty
• Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.