Healthcare Provider Details

I. General information

NPI: 1285582676
Provider Name (Legal Business Name): TSE-MIN SU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S PRESTON ST
LEWISVILLE KY
40202-1701
US

IV. Provider business mailing address

501 S PRESTON ST
LEWISVILLE KY
40202-1701
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-1239
  • Fax:
Mailing address:
  • Phone: 346-428-9472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberD-00156
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: