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NPI Code Detail

MEDICARE: KYUNG JOON SUH

MEDICARE: KYUNG JOON SUH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorASW 34403CA
2101YM0800XMental Health CounselorLCSW80442CA
31041C0700XClinical Social WorkerLCSW80442CA

General Provider Information

NPI Number : 1548517980
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYUNG JOON SUH
Provider Business Mailing Address
First Line : 3727 W 6TH ST STE 210
Second Line :
City : LOS ANGELES
State : CA
Zip : 90020-5108
Country : US
Telephone Number : 213-235-1219
Fax Number :
Provider Business Practice Location Address
First Line : 3255 WILSHIRE BLVD STE 120
Second Line :
City : LOS ANGELES
State : CA
Zip : 90010-1405
Country : US
Telephone Number : 213-235-1219
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2012
Last Update Date : 09/17/2019

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Directions to “ KYUNG JOON SUH ” Practice Location

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