Provider Demographics
NPI:1588656664
Name:SUH, YONG SUK (DPM)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:SUK
Last Name:SUH
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 W BADDOUR PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2674
Mailing Address - Country:US
Mailing Address - Phone:615-453-5440
Mailing Address - Fax:615-453-5441
Practice Address - Street 1:1405 W BADDOUR PKWY
Practice Address - Street 2:STE 104
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2674
Practice Address - Country:US
Practice Address - Phone:615-453-5440
Practice Address - Fax:615-453-5441
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM425213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3352060Medicaid
TN1273890001Medicare NSC
TN3352060Medicaid
TN3352060Medicare PIN