Basic Information
| Provider Information | |||||||||
| NPI: | 1851748438 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUPAKUWANA-SUK | ||||||||
| FirstName: | GILLIAN | ||||||||
| MiddleName: | VIMBAI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 YORK ST | ||||||||
| Address2: | YNHH DEPT OF MEDICINE, LMP 1092 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036885555 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 YORK ST | ||||||||
| Address2: | YNHH DEPT OF MEDICINE, LMP 1092 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036885555 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2016 | ||||||||
| LastUpdateDate: | 09/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 298769 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.