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General NPI Number Information
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NPI Number | 1003881830
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Entity Type | Individual
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Provider Name | TEDDY SU MD
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Gender | Male
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 101 BODIN CIR 60TH MEDICAL GROUP
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City | TRAVIS AFB
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State | CA
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Zip | 94535-1809
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Country | US
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Telephone | 707-423-7181
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Fax |
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Provider Business Mailing Address
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Address Line | 40087 MISSION BLVD # 250
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City | FREMONT
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State | CA
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Zip | 94539-3680
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 105730
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License Number State | CA
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