Provider Demographics
NPI:1073696415
Name:SUH, YAE K (MD)
Entity Type:Individual
Prefix:DR
First Name:YAE
Middle Name:K
Last Name:SUH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:SUH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5856 CORPORATE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630
Mailing Address - Country:US
Mailing Address - Phone:714-236-4000
Mailing Address - Fax:714-236-4006
Practice Address - Street 1:1001 N TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3502
Practice Address - Country:US
Practice Address - Phone:714-953-3381
Practice Address - Fax:714-953-3541
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53941207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A539410Medicaid
CA00A539410Medicaid
CAWA53941CMedicare PIN
CAWA53941BMedicare PIN