Provider Demographics
NPI:1194214072
Name:SUH, JI YEN (DMD)
Entity Type:Individual
Prefix:
First Name:JI YEN
Middle Name:
Last Name:SUH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 PARKER AVE APT 16F
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7006
Mailing Address - Country:US
Mailing Address - Phone:201-889-1070
Mailing Address - Fax:
Practice Address - Street 1:1600 PARKER AVE APT 16F
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7006
Practice Address - Country:US
Practice Address - Phone:201-889-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-06
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
NY0607721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program