Basic Information
| Provider Information | |||||||||
| NPI: | 1073696415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUH | ||||||||
| FirstName: | YAE | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SUH | ||||||||
| OtherFirstName: | KAY | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5856 CORPORATE AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CYPRESS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142364000 | ||||||||
| FaxNumber: | 7142364006 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 N TUSTIN AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149533381 | ||||||||
| FaxNumber: | 7149533541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2006 | ||||||||
| LastUpdateDate: | 10/05/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | A53941 | CA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 00A539410 | 05 | CA | MEDICAID |