Healthcare Provider Details

I. General information

NPI: 1225024722
Provider Name (Legal Business Name): JASON J SUH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JASON JUNG-GON SUH MD

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 SHERIDAN ST
PORT TOWNSEND WA
98368-2443
US

IV. Provider business mailing address

1155 MILL ST # M14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 360-344-3091
  • Fax: 360-344-3082
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number25341
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD00034987
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: