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General NPI Number Information
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NPI Number | 1407804172
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Entity Type | Individual
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Provider Name | EDWARD S. SUH D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 12/27/2018
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Provider Practice Location Address
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Address Line | 8575 KNOTT AVE SUITE A
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City | BUENA PARK
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State | CA
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Zip | 90620
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Country | US
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Telephone | 714-761-8575
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Fax | 714-761-8030
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Provider Business Mailing Address
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Address Line | 8575 KNOTT AVE #A
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City | BUENA PARK
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State | CA
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Zip | 90620
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Country | US
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Telephone | 714-761-8575
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Fax | 714-761-8030
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 52115
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License Number State | CA
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