Provider Demographics
NPI:1619034998
Name:SUH, INAE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:INAE
Middle Name:J
Last Name:SUH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S BEACH BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1812
Mailing Address - Country:US
Mailing Address - Phone:714-828-6500
Mailing Address - Fax:714-828-4365
Practice Address - Street 1:515 S BEACH BLVD STE D
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1812
Practice Address - Country:US
Practice Address - Phone:714-828-6500
Practice Address - Fax:714-828-4365
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38368122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist