Provider Demographics
NPI:1417574633
Name:SU, STEVEN TINGGANG (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:TINGGANG
Last Name:SU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1251 LEMON TREE DR
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6910
Mailing Address - Country:US
Mailing Address - Phone:562-565-4819
Mailing Address - Fax:
Practice Address - Street 1:17572 COLIMA RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-1754
Practice Address - Country:US
Practice Address - Phone:626-810-2022
Practice Address - Fax:626-810-0993
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist