Healthcare Provider Details

I. General information

NPI: 1053466011
Provider Name (Legal Business Name): HUI-CHUN IRENE SU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRENE SU MD

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 GENESEE AVE
SAN DIEGO CA
92121-2111
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 858-249-6751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA 110340
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD 422907
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: