MEDICARE: MR. STEVEN DAVID 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
1	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	96476	CA

General Provider Information

NPI Number	:	1497006852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN DAVID SU

Provider Business Mailing Address
First Line	:	440 E COMMONWEALTH AVE STE 209
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92832-2014
Country	:	US
Telephone Number	:	714-388-6684
Fax Number	:

Provider Business Practice Location Address
First Line	:	3375 S HOOVER ST
Second Line	:	SUITE H-201
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0116
Country	:	US
Telephone Number	:	213-821-5927
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2012
Last Update Date	:	03/08/2021

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