Provider Demographics
NPI:1437210184
Name:SUH, TIMOTHY IN JAE (L AC, MSOM)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:IN JAE
Last Name:SUH
Suffix:
Gender:M
Credentials:L AC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 W NORTH AVE
Mailing Address - Street 2:#1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1312
Mailing Address - Country:US
Mailing Address - Phone:773-227-9150
Mailing Address - Fax:773-227-9160
Practice Address - Street 1:1834 W NORTH AVE
Practice Address - Street 2:#1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1312
Practice Address - Country:US
Practice Address - Phone:773-227-9150
Practice Address - Fax:773-227-9160
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000610171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist