Provider Demographics
NPI:1447316104
Name:SUK, CHANG HO (MD)
Entity type:Individual
Prefix:
First Name:CHANG HO
Middle Name:
Last Name:SUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 61 KISSENA BLVD
Mailing Address - Street 2:SUITE # 27
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-461-6212
Mailing Address - Fax:718-539-1238
Practice Address - Street 1:41 61 KISSENA BLVD
Practice Address - Street 2:SUITE # 27
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-461-6212
Practice Address - Fax:718-539-1238
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151095207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00837834Medicaid
NY00837834Medicaid
D04028Medicare UPIN