Provider Demographics
NPI:1740271410
Name:JI, SUO (DMD)
Entity type:Individual
Prefix:
First Name:SUO
Middle Name:
Last Name:JI
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 1:4411 E 5TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2015
Mailing Address - Country:US
Mailing Address - Phone:520-325-1098
Mailing Address - Fax:520-325-1112
Practice Address - Street 1:4411 E 5TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2015
Practice Address - Country:US
Practice Address - Phone:520-325-1098
Practice Address - Fax:520-325-1112
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD63391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice