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NPI Code Detail

MEDICARE: SU MI HYUN LVN

MEDICARE: SU MI HYUN LVN
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
1164X00000XLicensed Vocational NurseVN736315CA

General Provider Information

NPI Number : 1699585885
Entity Type Code : Individual
Provider Name (Legal Business Name) : SU MI HYUN LVN
Provider Business Mailing Address
First Line : 2403 PROFESSIONAL DR
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-3007
Country : US
Telephone Number : 707-360-4387
Fax Number :
Provider Business Practice Location Address
First Line : 790 SONOMA AVE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95404-4713
Country : US
Telephone Number : 707-360-4368
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2025
Last Update Date : 01/09/2025

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