MEDICARE: HUI-CHUN IRENE SU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VE0102X	Reproductive Endocrinology Physician	A 110340	CA
2	207VE0102X	Reproductive Endocrinology Physician	MD 422907	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110340	OTHER	CA	CA MEDICAL LICENSE
2	F1425240	OTHER	CA	DRIVER'S LICENSE

General Provider Information

NPI Number	:	1053466011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUI-CHUN IRENE SU

Provider Business Mailing Address
First Line	:	PO BOX 232410
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92193-2410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9333 GENESEE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-2111
Country	:	US
Telephone Number	:	858-249-6751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	03/04/2020

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Directions to “ HUI-CHUN IRENE SU ” Practice Location

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