MEDICARE: DR. STEVEN K. SUE D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	790	HI

General Provider Information

NPI Number	:	1487888913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN K. SUE D.D.S.

Provider Business Mailing Address
First Line	:	2065 S KING ST STE 304
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96826-2225
Country	:	US
Telephone Number	:	808-949-8876
Fax Number	:	808-949-8878

Provider Business Practice Location Address
First Line	:	2065 S KING ST STE 304
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96826-2225
Country	:	US
Telephone Number	:	808-949-8876
Fax Number	:	808-949-8878

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

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	05/12/2009

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