Healthcare Provider Details

I. General information

NPI: 1598693137
Provider Name (Legal Business Name): SU MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W OLYMPIC BLVD STE 210
LOS ANGELES CA
90006-2640
US

IV. Provider business mailing address

1014 BROADWAY # 109
SANTA MONICA CA
90401-2808
US

V. Phone/Fax

Practice location:
  • Phone: 424-432-2304
  • Fax:
Mailing address:
  • Phone: 424-432-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEANNIE SU
Title or Position: CEO
Credential: MD
Phone: 424-432-2304