Provider Demographics
NPI:1922265404
Name:SUH, JESSE JONG-SHIK (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:JONG-SHIK
Last Name:SUH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WALNUT ST STE 1128
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2913
Mailing Address - Country:US
Mailing Address - Phone:215-207-9373
Mailing Address - Fax:
Practice Address - Street 1:1601 WALNUT ST STE 1128
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2913
Practice Address - Country:US
Practice Address - Phone:215-207-9373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68 017624103TC0700X
PAPS016534103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical