Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | B31171 | CA |
N | 213EG0000X | General Practice | B31171 | CA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | B31171 | CA |
NPI | 1073643128 |
---|---|
Provider Name | Hong Suk Suh |
First Address | Northridge, CA 91324 |
Second Address | Northridge, CA 91324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 23/07/2019 |