Provider Demographics
NPI:1225024722
Name:SUH, JASON J (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:J
Last Name:SUH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:JUNG-GON
Other - Last Name:SUH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5775
Practice Address - Street 1:75 PRINGLE WAY STE 801
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-8400
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-2821
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV25341207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV25341OtherNV MD LICENSE
NV11451923OtherCAQH
ILK15796OtherMEDICARE INDIV ID# FOR GROUP 336140
IL036-106371Medicaid
ILK15797OtherMEDICARE INDIV ID# FOR GROUP 205474
IL336140Medicare PIN
ILH25649Medicare UPIN
ILP00205012OtherMEDICARE RR