Provider Demographics
NPI:1881704740
Name:SUH, DONGMIN (MD)
Entity type:Individual
Prefix:DR
First Name:DONGMIN
Middle Name:
Last Name:SUH
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 1:12555 GARDEN GROVE BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1904
Mailing Address - Country:US
Mailing Address - Phone:714-636-0322
Mailing Address - Fax:714-636-9694
Practice Address - Street 1:12555 GARDEN GROVE BLVD STE 406
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1904
Practice Address - Country:US
Practice Address - Phone:714-636-0322
Practice Address - Fax:714-636-9694
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33687208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A336870Medicaid