Provider Demographics
NPI:1194711184
Name:SUH, CHARLES YH (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:YH
Last Name:SUH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E VALENCIA MESA DR STE 206
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3817
Mailing Address - Country:US
Mailing Address - Phone:714-446-5050
Mailing Address - Fax:
Practice Address - Street 1:100 E VALENCIA MESA DR STE 206
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3817
Practice Address - Country:US
Practice Address - Phone:714-446-5050
Practice Address - Fax:714-446-5150
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69440207RC0000X, 207RI0011X
ARG69440207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE21217Medicare UPIN
CAWG69440BMedicare PIN