Provider Demographics
NPI:1730309162
Name:SUESS, KORINE DENISE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KORINE
Middle Name:DENISE
Last Name:SUESS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KORINE
Other - Middle Name:DENISE
Other - Last Name:STAEHELI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:652 ORANGE GROVE AVE
Mailing Address - Street 2:APT B
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2353
Mailing Address - Country:US
Mailing Address - Phone:253-988-6616
Mailing Address - Fax:
Practice Address - Street 1:837 S FAIR OAKS AVE
Practice Address - Street 2:#203
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2628
Practice Address - Country:US
Practice Address - Phone:626-793-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22891124Q00000X
WADH00006553124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22891OtherR.D.H. LICENSE NUMBER