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General NPI Number Information
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NPI Number | 1902223969
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Entity Type | Individual
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Provider Name | WADE SU D.M.D
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Gender | Male
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 18822 NORWALK BLVD
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City | ARTESIA
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State | CA
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Zip | 90701-5973
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Country | US
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Telephone | 562-809-3899
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Fax | 562-865-1221
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Provider Business Mailing Address
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Address Line | 18822 NORWALK BLVD
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City | ARTESIA
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State | CA
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Zip | 90701-5973
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Country | US
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Telephone | 562-809-3899
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Fax | 562-865-1221
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 63145
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License Number State | CA
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