Provider Demographics
NPI:1740200351
Name:SUH, WILLIAM MYOUNGWON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MYOUNGWON
Last Name:SUH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 BROCKTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-0104
Mailing Address - Country:US
Mailing Address - Phone:951-585-1800
Mailing Address - Fax:951-585-1801
Practice Address - Street 1:4646 BROCKTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-0104
Practice Address - Country:US
Practice Address - Phone:951-585-1800
Practice Address - Fax:951-585-1801
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85060207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A850600Medicaid
CAI31577Medicare UPIN
CA00A850600Medicaid