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General NPI Number Information
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NPI Number | 1134771561
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Entity Type | Individual
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Provider Name | TENGFEI SU
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Gender | Male
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 18121 CHATSWORTH ST STE A
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City | GRANADA HILLS
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State | CA
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Zip | 91344-5610
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Country | US
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Telephone | 818-360-2131
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Fax |
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Provider Business Mailing Address
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Address Line | 64 N MAR VISTA AVE APT 105
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City | PASADENA
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State | CA
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Zip | 91106-1471
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 107615
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License Number State | CA
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