Provider Demographics
NPI:1225138035
Name:SU, ZEN-NI (OD)
Entity Type:Individual
Prefix:
First Name:ZEN-NI
Middle Name:
Last Name:SU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 LOMITA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1437
Mailing Address - Country:US
Mailing Address - Phone:310-534-1873
Mailing Address - Fax:
Practice Address - Street 1:2245 LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1437
Practice Address - Country:US
Practice Address - Phone:310-534-1873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12006T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0120060Medicaid
CAOPT12006TOtherOTHER INS
CAU79757Medicare UPIN
CAOP12006AMedicare ID - Type Unspecified