Provider Demographics
NPI:1558577007
Name:SUK, EUI YOUNG (DENTURIST)
Entity Type:Individual
Prefix:MR
First Name:EUI
Middle Name:YOUNG
Last Name:SUK
Suffix:
Gender:M
Credentials:DENTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9234 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4532
Mailing Address - Country:US
Mailing Address - Phone:503-254-4823
Mailing Address - Fax:503-254-4823
Practice Address - Street 1:9234 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4532
Practice Address - Country:US
Practice Address - Phone:503-254-4823
Practice Address - Fax:503-254-4823
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDTDO918828122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR069168Medicaid