Provider Demographics
NPI:1720581382
Name:SUK MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:SUK MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:TARYOUNG
Authorized Official - Last Name:SUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-515-9871
Mailing Address - Street 1:15435 S WESTERN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4324
Mailing Address - Country:US
Mailing Address - Phone:310-515-9874
Mailing Address - Fax:
Practice Address - Street 1:15435 S WESTERN AVE STE 201
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4324
Practice Address - Country:US
Practice Address - Phone:310-515-9874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUK MEDICAL CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52233207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty