Provider Demographics
NPI:1326342569
Name:SUH, BON YOUNG (LAC)
Entity Type:Individual
Prefix:
First Name:BON YOUNG
Middle Name:
Last Name:SUH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 PICCARD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6067
Mailing Address - Country:US
Mailing Address - Phone:202-999-8986
Mailing Address - Fax:646-478-9778
Practice Address - Street 1:1712 EYE ST NW
Practice Address - Street 2:503
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3702
Practice Address - Country:US
Practice Address - Phone:202-999-8986
Practice Address - Fax:646-478-9778
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC500180171100000X
MDU02089171100000X
VA0121000718171100000X
NY171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist