Healthcare Provider Details

I. General information

NPI: 1447656863
Provider Name (Legal Business Name): MRS. BING SU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

663 S KING ST
SEATTLE WA
98104-2937
US

IV. Provider business mailing address

663 S KING ST
SEATTLE WA
98104-2937
US

V. Phone/Fax

Practice location:
  • Phone: 206-292-9646
  • Fax: 206-292-9650
Mailing address:
  • Phone: 206-292-9646
  • Fax: 206-292-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60524137
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: