Provider Demographics
NPI:1619902509
Name:SUK, HWAN Z (M D)
Entity Type:Individual
Prefix:
First Name:HWAN
Middle Name:Z
Last Name:SUK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E CHEVY CHASE DR STE 240
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4140
Mailing Address - Country:US
Mailing Address - Phone:818-548-7178
Mailing Address - Fax:818-548-7187
Practice Address - Street 1:1560 E CHEVY CHASE DR STE 240
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4140
Practice Address - Country:US
Practice Address - Phone:818-548-7178
Practice Address - Fax:818-548-7187
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA61077Medicaid
CAA61077Medicaid
CAA61077CMedicare ID - Type Unspecified