Provider Demographics
NPI:1881965234
Name:BO Y SUH MD INC
Entity type:Organization
Organization Name:BO Y SUH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BO
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-643-9204
Mailing Address - Street 1:12555 GARDEN GROVE BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1903
Mailing Address - Country:US
Mailing Address - Phone:714-643-9203
Mailing Address - Fax:714-643-9205
Practice Address - Street 1:12555 GARDEN GROVE BLVD STE 401
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1903
Practice Address - Country:US
Practice Address - Phone:714-643-9203
Practice Address - Fax:714-643-9205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty