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NPI Code Detail

MEDICARE: WONSUK WARREN SUH M.D., M.P.H.

MEDICARE: WONSUK WARREN SUH M.D., M.P.H.
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
12085R0001XRadiation Oncology PhysicianC53785CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CI006YOTHERCAMEDICARE PTAN

General Provider Information

NPI Number : 1023068541
Entity Type Code : Individual
Provider Name (Legal Business Name) : WONSUK WARREN SUH M.D., M.P.H.
Provider Business Mailing Address
First Line : SANSUM CLINIC
Second Line : P.O. BOX 62106
City : SANTA BARBARA
State : CA
Zip : 93106-2106
Country : US
Telephone Number : 805-682-7300
Fax Number :
Provider Business Practice Location Address
First Line : 300 W PUEBLO ST
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93105-4311
Country : US
Telephone Number : 805-682-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 10/21/2014

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