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General NPI Number Information
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NPI Number | 1619562543
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Entity Type | Individual
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Provider Name | FANG-YU SU DMD
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Gender | Female
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 3223 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5007
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Country | US
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Telephone | 215-531-3603
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Fax |
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Provider Business Mailing Address
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Address Line | 3223 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5007
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Country | US
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Telephone | 215-926-2350
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 12013481A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 019.032873
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | RFD000042
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License Number State | PA
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