Provider Demographics
NPI:1558051946
Name:AH SUE, JEREMY JAMES
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:JAMES
Last Name:AH SUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 N 850 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1423
Mailing Address - Country:US
Mailing Address - Phone:951-232-0090
Mailing Address - Fax:
Practice Address - Street 1:768 N 850 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1423
Practice Address - Country:US
Practice Address - Phone:951-232-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program