Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D30956 | TX |
Y | 213EG0000X | General Practice | D30956 | TX |
NPI | 1003284969 |
---|---|
Provider Name | Miss Eunjin M Suh |
First Address | Keller, TX 76248-5677 |
Second Address | Fort Worth, TX 76137-4400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2015 |
Last Update Date | 09/09/2015 |