Provider Demographics
NPI:1558356477
Name:SUH, JENNIFER JIN-KYUNG (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JIN-KYUNG
Last Name:SUH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-1204
Mailing Address - Country:US
Mailing Address - Phone:215-441-5670
Mailing Address - Fax:
Practice Address - Street 1:483 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040
Practice Address - Country:US
Practice Address - Phone:215-441-5670
Practice Address - Fax:215-441-5661
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122267208000000X
PAMD424483208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01011767630001Medicaid
PAMD424483OtherSTATE LICENSE NUMBER
IL036-122267OtherSTATE LICENSE NUMBER
PAMD424483OtherSTATE LICENSE NUMBER
PAI27698Medicare UPIN