Healthcare Provider Details

I. General information

NPI: 1538158746
Provider Name (Legal Business Name): JAMES Y. SU, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 181ST ST SUITE 24
NEW YORK NY
10033-4914
US

IV. Provider business mailing address

601 W 181ST ST SUITE 24
NEW YORK NY
10033-4914
US

V. Phone/Fax

Practice location:
  • Phone: 212-928-4800
  • Fax: 212-928-3436
Mailing address:
  • Phone: 212-928-4800
  • Fax: 212-928-3436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number041389
License Number StateNY

VIII. Authorized Official

Name: DR. JAMES Y. SU
Title or Position: PRESIDENT
Credential: DDS
Phone: 212-928-4800