Provider Demographics
NPI:1902112360
Name:TSE, SUK Y (LAC)
Entity Type:Individual
Prefix:
First Name:SUK
Middle Name:Y
Last Name:TSE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:278 LUNETA DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1520
Mailing Address - Country:US
Mailing Address - Phone:818-442-7591
Mailing Address - Fax:818-477-0670
Practice Address - Street 1:1177 PALM ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3113
Practice Address - Country:US
Practice Address - Phone:805-439-2180
Practice Address - Fax:818-477-0670
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA12629171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist