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General NPI Number Information
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NPI Number | 1194058669
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Entity Type | Individual
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Provider Name | HUAN SU D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 2302 S UNION AVE BUILDING C SUITE 22
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City | TACOMA
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State | WA
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Zip | 98405-1300
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Country | US
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Telephone | 253-752-6336
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 LAKE WASHINGTON BLVD N APT A302
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City | RENTON
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State | WA
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Zip | 98056-2564
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Country | US
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Telephone | 425-988-4755
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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 | DE60101496
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DE60101496
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License Number State | WA
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