Healthcare Provider Details

I. General information

NPI: 1336556851
Provider Name (Legal Business Name): CHENGHUI SU D. O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHENGHUI SU D.O

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 E PACIFIC COAST HWY STE 600
LONG BEACH CA
90804-6914
US

IV. Provider business mailing address

11301 WILSHIRE BLVD BLD500, RM6428
LOS ANGELES CA
90073
US

V. Phone/Fax

Practice location:
  • Phone: 562-346-1100
  • Fax:
Mailing address:
  • Phone: 310-748-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number20A17008
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A17008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: