Provider Demographics
NPI:1922537414
Name:SUKYS, JORDAN (MD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:SUKYS
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 1:10 CONGRESS ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3027
Mailing Address - Country:US
Mailing Address - Phone:626-796-6164
Mailing Address - Fax:626-796-0883
Practice Address - Street 1:10 CONGRESS ST STE 103
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3027
Practice Address - Country:US
Practice Address - Phone:626-796-6164
Practice Address - Fax:626-796-0883
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175461207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty