MEDICARE: DR. SEAN SU MD

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	207Q00000X	Family Medicine Physician	9013	NV

General Provider Information

NPI Number	:	1760597405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN SU MD

Provider Business Mailing Address
First Line	:	2451 PROFESSIONAL CT STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0827
Country	:	US
Telephone Number	:	702-240-4242
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 PROFESSIONAL CT STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0827
Country	:	US
Telephone Number	:	702-240-4242
Fax Number	:

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/31/2022

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