Provider Demographics
NPI:1851748438
Name:KUPAKUWANA-SUK, GILLIAN VIMBAI (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:VIMBAI
Last Name:KUPAKUWANA-SUK
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 YORK ST
Mailing Address - Street 2:YNHH DEPT OF MEDICINE, LMP 1092
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3221
Mailing Address - Country:US
Mailing Address - Phone:203-688-5555
Mailing Address - Fax:
Practice Address - Street 1:15 YORK ST
Practice Address - Street 2:YNHH DEPT OF MEDICINE, LMP 1092
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3221
Practice Address - Country:US
Practice Address - Phone:203-688-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298769207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine