Provider Demographics
NPI:1720205263
Name:SUK, MINJEONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:MINJEONG
Middle Name:
Last Name:SUK
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 1:7806 SUDLEY RD
Mailing Address - Street 2:#210
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2859
Mailing Address - Country:US
Mailing Address - Phone:703-331-1313
Mailing Address - Fax:703-369-2622
Practice Address - Street 1:7806 SUDLEY RD
Practice Address - Street 2:#210
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2859
Practice Address - Country:US
Practice Address - Phone:703-331-1313
Practice Address - Fax:703-369-2622
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014114451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice