Provider Demographics
NPI:1699968503
Name:PUDUNAGAR SUBBIAH, SHANMUGA S (MD)
Entity type:Individual
Prefix:DR
First Name:SHANMUGA
Middle Name:S
Last Name:PUDUNAGAR SUBBIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 SAN BERNARDINO RD STE 1100
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4952
Practice Address - Country:US
Practice Address - Phone:909-949-2242
Practice Address - Fax:909-981-5783
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA119729207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology