MEDICARE: CHAE SUH, M.D., A MEDICAL CORPORATION

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	207L00000X	Anesthesiology Physician	A89391	CA

General Provider Information

NPI Number	:	1376636316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAE SUH, M.D., A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	225 S LAKE AVE
Second Line	:	#535
City	:	PASADENA
State	:	CA
Zip	:	91101-3005
Country	:	US
Telephone Number	:	626-795-6596
Fax Number	:	626-795-8247

Provider Business Practice Location Address
First Line	:	201 W GARVEY AVE
Second Line	:	#201
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-7418
Country	:	US
Telephone Number	:	626-280-3393
Fax Number	:	626-280-2931

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHAE JIN SUH
Credential	:	M.D.
Telephone Number	:	818-507-0174

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/22/2020

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