Healthcare Provider Details

I. General information

NPI: 1609261528
Provider Name (Legal Business Name): ERIK CHEN SU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE MLC 4000
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVENUE MLC 4000
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4681
  • Fax: 513-636-7844
Mailing address:
  • Phone: 513-636-4681
  • Fax: 513-636-7844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA154474
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number35.142651
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU5821
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: