Basic Information
| Provider Information | |||||||||
| NPI: | 1558385039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SURH | ||||||||
| FirstName: | TAEMIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.A.-C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 WHIPPLE AVE | ||||||||
| Address2: | SUITE140 | ||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940622843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502612366 | ||||||||
| FaxNumber: | 6502612369 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 WHIPPLE AVE | ||||||||
| Address2: | SUITE140 | ||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940622843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502612366 | ||||||||
| FaxNumber: | 6502612369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 07/17/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA11966 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | CP2153 | 01 | CA | RAILROAD MEDICARE | OTHER | GR0052800 | 05 | CA | MEDICAID |