Provider Demographics
NPI:1023068541
Name:SUH, WONSUK WARREN (MD, MPH)
Entity type:Individual
Prefix:
First Name:WONSUK
Middle Name:WARREN
Last Name:SUH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SANSUM CLINIC
Mailing Address - Street 2:P.O. BOX 62106
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93106-2106
Mailing Address - Country:US
Mailing Address - Phone:805-682-7300
Mailing Address - Fax:
Practice Address - Street 1:300 W PUEBLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4311
Practice Address - Country:US
Practice Address - Phone:805-682-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC537852085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACI006YOtherMEDICARE PTAN