Provider Demographics
NPI:1124124243
Name:SUH & SUH MD INC
Entity type:Organization
Organization Name:SUH & SUH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JUNG
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-946-1414
Mailing Address - Street 1:725 KAPIOLANI BLVD STE C114
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-6016
Mailing Address - Country:US
Mailing Address - Phone:808-946-1414
Mailing Address - Fax:808-946-1515
Practice Address - Street 1:725 KAPIOLANI BLVD STE C114
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6016
Practice Address - Country:US
Practice Address - Phone:808-946-1414
Practice Address - Fax:808-946-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2519207RE0101X
HI10040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50149601Medicaid
HI03532001Medicaid
HI03532001Medicaid
HI50149601Medicaid
HI52298Medicare ID - Type Unspecified
HIH09530Medicare UPIN
HI52297Medicare ID - Type Unspecified