Provider Demographics
NPI:1518934009
Name:SUH, PHILIP JUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JUNG
Last Name:SUH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 KAPIOLANI BLVD STE C114
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-6016
Mailing Address - Country:US
Mailing Address - Phone:808-946-1414
Mailing Address - Fax:808-946-1515
Practice Address - Street 1:725 KAPIOLANI BLVD STE C114
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6016
Practice Address - Country:US
Practice Address - Phone:808-946-1414
Practice Address - Fax:808-946-1515
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10040208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50149601Medicaid
52311Medicare ID - Type Unspecified
HI50149601Medicaid