Provider Demographics
NPI:1174664031
Name:SUH, YONGSOOK VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:YONGSOOK
Middle Name:VICTORIA
Last Name:SUH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8503 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4628
Mailing Address - Country:US
Mailing Address - Phone:703-846-0097
Mailing Address - Fax:703-846-0802
Practice Address - Street 1:8503 ARLINGTON BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4628
Practice Address - Country:US
Practice Address - Phone:703-846-0097
Practice Address - Fax:703-846-0802
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057456174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G91539Medicare UPIN
G01499Medicare PIN