Provider Demographics
NPI:1194713131
Name:SUH, YOO TAIK (MD)
Entity type:Individual
Prefix:
First Name:YOO
Middle Name:TAIK
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 1:1871 EVELYN BYRD AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3487
Mailing Address - Country:US
Mailing Address - Phone:540-564-5800
Mailing Address - Fax:
Practice Address - Street 1:1871 EVELYN BYRD AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3487
Practice Address - Country:US
Practice Address - Phone:540-564-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101277286207R00000X, 207RG0100X
NC2021-02420207RG0100X
FLME132993207RG0100X
KY39503207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000371086OtherBCBS
KY64103005Medicaid
KY1965501Medicare ID - Type Unspecified
KYF45900Medicare UPIN