MEDICARE: MICHAEL SUH DDS DENTAL PRACTICE PC

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
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1154198109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL SUH DDS DENTAL PRACTICE PC

Provider Business Mailing Address
First Line	:	33800 ALVARADO NILES RD STE 7
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4359
Country	:	US
Telephone Number	:	510-477-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	33800 ALVARADO NILES RD STE 7
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4359
Country	:	US
Telephone Number	:	510-477-6727
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PEDIATRIC DENTIST
Name	:	DR. MICHAEL SUH
Credential	:	DDS
Telephone Number	:	408-891-2867

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/11/2023

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