MEDICARE: DR. KENNY C SU M.D.

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	207RG0100X	Gastroenterology Physician	A43900	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437141918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNY C SU M.D.

Provider Business Mailing Address
First Line	:	3120 S HACIENDA BLVD
Second Line	:	SUITE 103
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-6305
Country	:	US
Telephone Number	:	626-855-1091
Fax Number	:	626-369-5988

Provider Business Practice Location Address
First Line	:	3120 S HACIENDA BLVD
Second Line	:	SUITE 103
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-6305
Country	:	US
Telephone Number	:	626-855-1091
Fax Number	:	626-369-5988

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	12/12/2008

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Directions to “ DR. KENNY C SU M.D.” Practice Location

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