Healthcare Provider Details

I. General information

NPI: 1609628882
Provider Name (Legal Business Name): SUSIE SUH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MEDICAL SURG I
IRVINE CA
92697-0001
US

IV. Provider business mailing address

118 MEDICAL SURGE I
IRVINE CA
92697-0001
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-5515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA204979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: