Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 35774 | TX |
N | 1223G0001X | General Practice | 35774 | TX |
N | 213EG0000X | General Practice | 35774 | TX |
NPI | 1003441890 |
---|---|
Provider Name | Dr. Ethan Suh |
First Address | Katy, TX 77494-7906 |
Second Address | Sealy, TX 77474-2744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2020 |
Last Update Date | 11/01/2021 |