Provider Demographics
NPI:1831119916
Name:SUH, YOOSUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:YOOSUNG
Middle Name:
Last Name:SUH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 DEKALB PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1812
Mailing Address - Country:US
Mailing Address - Phone:610-277-4811
Mailing Address - Fax:610-277-4896
Practice Address - Street 1:1040 DEKALB PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1812
Practice Address - Country:US
Practice Address - Phone:610-277-4811
Practice Address - Fax:610-277-4896
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0300621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA201380662OtherTAX ID NUMBER