Provider Demographics
NPI:1811376056
Name:SUK, SOJUNG (DNP)
Entity Type:Individual
Prefix:DR
First Name:SOJUNG
Middle Name:
Last Name:SUK
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 WILSHIRE BLVD STE 170-14
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3519
Mailing Address - Country:US
Mailing Address - Phone:323-272-3648
Mailing Address - Fax:323-272-3680
Practice Address - Street 1:4221 WILSHIRE BLVD STE 170-14
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3519
Practice Address - Country:US
Practice Address - Phone:323-272-3648
Practice Address - Fax:323-272-3680
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95000386363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health