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NPI Code Detail

MEDICARE: MALCOLM SU

MEDICARE: MALCOLM 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
1207R00000XInternal Medicine PhysicianW4209TX

General Provider Information

NPI Number : 1790487056
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALCOLM SU
Provider Business Mailing Address
First Line : 5323 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75390-7201
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5323 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75390-7201
Country : US
Telephone Number : 214-648-3486
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2023
Last Update Date : 04/15/2026

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Directions to “ MALCOLM SU ” Practice Location

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