Provider Demographics
NPI:1053466011
Name:SU, HUI-CHUN IRENE
Entity Type:Individual
Prefix:
First Name:HUI-CHUN
Middle Name:IRENE
Last Name:SU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:SU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9333 GENESEE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2111
Practice Address - Country:US
Practice Address - Phone:858-249-6751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 110340207VE0102X
PAMD 422907207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110340OtherCA MEDICAL LICENSE
CAF1425240OtherDRIVER'S LICENSE