Provider Demographics
NPI:1477873073
Name:WEIZHONG SU DDS INC
Entity Type:Organization
Organization Name:WEIZHONG SU DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WEIZHONG
Authorized Official - Middle Name:
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-969-7717
Mailing Address - Street 1:5567 N AZUSA AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-5544
Mailing Address - Country:US
Mailing Address - Phone:626-969-7717
Mailing Address - Fax:626-633-0800
Practice Address - Street 1:5567 N AZUSA AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-5544
Practice Address - Country:US
Practice Address - Phone:626-969-7717
Practice Address - Fax:626-633-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty