Healthcare Provider Details

I. General information

NPI: 1992048318
Provider Name (Legal Business Name): DAVID C SUH D D S INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 LOMITA BLVD STE 217
TORRANCE CA
90505-3958
US

IV. Provider business mailing address

3655 LOMITA BLVD STE 217
TORRANCE CA
90505-3958
US

V. Phone/Fax

Practice location:
  • Phone: 310-326-8572
  • Fax: 310-326-1991
Mailing address:
  • Phone: 310-326-8572
  • Fax: 310-326-1991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number51197
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID C SUH
Title or Position: PRESIDENT
Credential: DDS
Phone: 310-326-9572