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NPI Code Detail

MEDICARE: TENGFEI SU

MEDICARE: TENGFEI SU
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist107615CA

General Provider Information

NPI Number : 1134771561
Entity Type Code : Individual
Provider Name (Legal Business Name) : TENGFEI SU
Provider Business Mailing Address
First Line : 64 N MAR VISTA AVE APT 105
Second Line :
City : PASADENA
State : CA
Zip : 91106-1471
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18121 CHATSWORTH ST STE A
Second Line :
City : GRANADA HILLS
State : CA
Zip : 91344-5610
Country : US
Telephone Number : 818-360-2131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2019
Last Update Date : 08/23/2023

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Directions to “ TENGFEI SU ” Practice Location

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