Provider Demographics
NPI:1487835625
Name:SU, SUSAN MEIFANG I (LAC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MEIFANG
Last Name:SU
Suffix:I
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 S BEVERLY DR STE 105
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4804
Mailing Address - Country:US
Mailing Address - Phone:310-552-8238
Mailing Address - Fax:310-552-8232
Practice Address - Street 1:300 S BEVERLY DR STE 105
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4804
Practice Address - Country:US
Practice Address - Phone:310-552-8238
Practice Address - Fax:310-552-8232
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4712171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist