| Suk Medical Clinic Inc | |
|
15435 S Western Ave Ste 201 Gardena CA 90249-4324 | |
| (310) 515-9874 | |
| Not Available |
| Full Name | Suk Medical Clinic Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 15435 S Western Ave Ste 201, Gardena, California |
| Authorized Official Name and Position | Larry Taryoung Suk (PHYSICIAN) |
| Authorized Official Contact | 3105159871 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Suk Medical Clinic Inc 15435 S Western Ave Ste 201 Gardena CA 90249-4324 Ph: (310) 515-9874 | Suk Medical Clinic Inc 15435 S Western Ave Ste 201 Gardena CA 90249-4324 Ph: (310) 515-9874 |
| NPI Number | 1720581382 |
|---|---|
| Provider Enumeration Date | 03/09/2018 |
| Last Update Date | 03/09/2018 |
| Medicare PECOS PAC ID | 8224393798 |
|---|---|
| Medicare Enrollment ID | O20180604002366 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720581382 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A52233 (California) | Primary |
| Provider Name | Larry Taryoung Suk |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912961939 PECOS PAC ID: 1658309133 Enrollment ID: I20050727000645 |
| Provider Name | Kyoung Jin Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609392919 PECOS PAC ID: 6002248689 Enrollment ID: I20191120001357 |
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