MEDICARE: DR. SU HWEI OU DDS

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	122300000X	Dentist	A37890	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871711937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SU HWEI OU DDS

Provider Business Mailing Address
First Line	:	5480 PHILADELPHIA ST
Second Line	:	STE D
City	:	CHINO
State	:	CA
Zip	:	91710-2486
Country	:	US
Telephone Number	:	909-464-2399
Fax Number	:	909-464-2398

Provider Business Practice Location Address
First Line	:	5480 PHILADELPHIA ST
Second Line	:	STE D
City	:	CHINO
State	:	CA
Zip	:	91710-2486
Country	:	US
Telephone Number	:	909-464-2399
Fax Number	:	909-464-2398

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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