Provider Demographics
NPI:1013190016
Name:SU, MICHAEL HUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HUNG
Last Name:SU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E HUNTINGTON DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1022
Mailing Address - Country:US
Mailing Address - Phone:818-308-7881
Mailing Address - Fax:818-308-7882
Practice Address - Street 1:100 E HUNTINGTON DR
Practice Address - Street 2:SUITE 206
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-1022
Practice Address - Country:US
Practice Address - Phone:818-308-7881
Practice Address - Fax:818-308-7882
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice