Healthcare Provider Details

I. General information

NPI: 1730541889
Provider Name (Legal Business Name): SUZAN HUA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 03/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

7731 OLD WOODSTOCK LN
ELLICOTT CITY MD
21043-6980
US

V. Phone/Fax

Practice location:
  • Phone: 510-703-4678
  • Fax:
Mailing address:
  • Phone: 510-703-4678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: