Healthcare Provider Details

I. General information

NPI: 1124124243
Provider Name (Legal Business Name): SUH & SUH MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 KAPIOLANI BLVD STE C114
HONOLULU HI
96813-6016
US

IV. Provider business mailing address

725 KAPIOLANI BLVD STE C114
HONOLULU HI
96813-6016
US

V. Phone/Fax

Practice location:
  • Phone: 808-946-1414
  • Fax: 808-946-1515
Mailing address:
  • Phone: 808-946-1414
  • Fax: 808-946-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2519
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10040
License Number StateHI

VIII. Authorized Official

Name: PHILIP JUNG SUH
Title or Position: OWNER
Credential: MD
Phone: 808-946-1414