Provider Demographics
NPI:1407024235
Name:YONG S SUH
Entity Type:Organization
Organization Name:YONG S SUH
Other - Org Name:FOOTCARE OF LEBANON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:SUK
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:PODIATRIST
Authorized Official - Phone:615-453-5440
Mailing Address - Street 1:100 PHYSICIANS WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-8102
Mailing Address - Country:US
Mailing Address - Phone:615-453-5440
Mailing Address - Fax:615-453-5441
Practice Address - Street 1:100 PHYSICIANS WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-8102
Practice Address - Country:US
Practice Address - Phone:615-453-5440
Practice Address - Fax:615-453-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM425213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1273890001Medicare NSC