Provider Demographics
NPI:1003109851
Name:CHI, SUEYOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUEYOUNG
Middle Name:
Last Name:CHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 BUCKLAND HILLS DR
Mailing Address - Street 2:SUITE 1076
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:194 BUCKLAND HILLS DR STE 1076
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8785
Practice Address - Country:US
Practice Address - Phone:860-644-0099
Practice Address - Fax:860-644-0109
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0104391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice