Healthcare Provider Details

I. General information

NPI: 1063501542
Provider Name (Legal Business Name): RUMIE SU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25965 NORMANDIE AVE
HARBOR CITY CA
90710-3416
US

IV. Provider business mailing address

393 E WALNUT ST 3RD FLOOR SE PHR SYSTEM
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-257-5179
  • Fax: 310-517-4520
Mailing address:
  • Phone: 626-405-7914
  • Fax: 626-405-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA51099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: