Provider Demographics
NPI:1346498870
Name:SUH, YOUNGUN (PA-C)
Entity Type:Individual
Prefix:
First Name:YOUNGUN
Middle Name:
Last Name:SUH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:SUITE 131Q
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6115
Mailing Address - Country:US
Mailing Address - Phone:978-927-7246
Mailing Address - Fax:978-927-7249
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 131Q
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-927-7246
Practice Address - Fax:978-927-7249
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002361363AM0700X
MAPA4246363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical