Provider Demographics
NPI:1538319967
Name:NING MIAO SU, DDS, MS, INC
Entity Type:Organization
Organization Name:NING MIAO SU, DDS, MS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NING MIAO
Authorized Official - Middle Name:
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:949-653-5868
Mailing Address - Street 1:PO BOX 5716
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92616-5716
Mailing Address - Country:US
Mailing Address - Phone:949-653-5868
Mailing Address - Fax:949-653-5860
Practice Address - Street 1:14200 CULVER DR
Practice Address - Street 2:SUITE 205
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0312
Practice Address - Country:US
Practice Address - Phone:949-653-5868
Practice Address - Fax:949-635-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty