Provider Demographics
NPI:1922005990
Name:AN, SUHYUN (DC)
Entity Type:Individual
Prefix:DR
First Name:SUHYUN
Middle Name:
Last Name:AN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 CAMPBELL RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-4752
Mailing Address - Country:US
Mailing Address - Phone:832-358-2225
Mailing Address - Fax:832-358-2226
Practice Address - Street 1:1012 CAMPBELL RD # 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055
Practice Address - Country:US
Practice Address - Phone:832-358-2225
Practice Address - Fax:832-358-2226
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9783111N00000X
TXAP137493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB143304Medicare PIN
TX611112Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID