Provider Demographics
NPI:1215474226
Name:SUK, AGATHA
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:
Last Name:SUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 C ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-5122
Mailing Address - Country:US
Mailing Address - Phone:510-889-8062
Mailing Address - Fax:510-537-6380
Practice Address - Street 1:917 C ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-5122
Practice Address - Country:US
Practice Address - Phone:510-889-8062
Practice Address - Fax:510-537-6380
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-28
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17463171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist